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Crowe EP, Diaz-Arias LA, Habis R, Vozniak SO, Geocadin RG, Venkatesan A, Tobian AAR, Probasco JC, Bloch EM. Suspected autoimmune encephalitis: A retrospective study of patients referred for therapeutic plasma exchange. J Clin Apher 2024; 39:e22112. [PMID: 38634442 DOI: 10.1002/jca.22112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/16/2024] [Accepted: 02/22/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Autoimmune encephalitis (AE) comprises a heterogeneous group of autoantibody-mediated disorders targeting the brain parenchyma. Therapeutic plasma exchange (TPE), one of several first-line therapies for AE, is often initiated when AE is suspected, albeit prior to an established diagnosis. We sought to characterize the role of TPE in the treatment of suspected AE. METHODS A single-center, retrospective analysis was performed of adults (≥18 years) who underwent at least one TPE procedure for "suspected AE." The following parameters were extracted and evaluated descriptively: clinicopathologic characteristics, treatment course, TPE-related adverse events, outcomes (e.g., modified Rankin scale [mRS]), and diagnosis once investigation was complete. RESULTS A total of 37 patients (median age 56 years, range 28-77 years, 62.2% male) were evaluated. Autoimmune antibody testing was positive in serum for 43.2% (n = 16) and cerebrospinal fluid for 29.7% (n = 11). Patients underwent a median of five TPE procedures (range 3-16), with 97.3% (n = 36) via a central line and 21.6% (n = 8) requiring at least one unit of plasma as replacement fluid. Fifteen patients (40.5%) experienced at least one TPE-related adverse event. Compared with mRS at admission, the mRS at discharge was improved in 21.6% (n = 8), unchanged in 59.5% (n = 22), or worse in 18.9% (n = 7). Final diagnosis of AE was determined to be definite in 48.6% (n = 18), probable in 8.1% (n = 3) and possible in 27.0% (n = 10). Six (16.2%) patients were ultimately determined to have an alternate etiology. CONCLUSION Empiric TPE for suspected AE is generally well-tolerated. However, its efficacy remains uncertain in the absence of controlled trials, particularly in the setting of seronegative disease.
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Affiliation(s)
- Elizabeth P Crowe
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Luisa A Diaz-Arias
- Johns Hopkins Encephalitis Center, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ralph Habis
- Johns Hopkins Encephalitis Center, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sonja O Vozniak
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Romergryko G Geocadin
- Johns Hopkins Encephalitis Center, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Arun Venkatesan
- Johns Hopkins Encephalitis Center, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John C Probasco
- Johns Hopkins Encephalitis Center, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Evan M Bloch
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Jacobs JW, Adkins BD, Bibb LA, Stephens LD, Woo JS, Bloch EM, Booth GS. New threats from an old foe: Evaluating the risk to the blood supply due to increasing incidence and endemicity of leprosy in the United States. Transfus Apher Sci 2024; 63:103877. [PMID: 38242725 DOI: 10.1016/j.transci.2024.103877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/21/2024]
Abstract
Leprosy (i.e., Hansen's disease) is a chronic disease secondary to infection with either Mycobacterium leprae or M. lepromatosis. While the incidence of this disease is decreasing across the world, there is mounting evidence that it might be increasing, and becoming endemic, in the United States. Leprosy was once considered a potential threat to the blood supply, and while this threat has not borne out, it is worth revisiting the available data to assess whether it may pose a threat in the future. Herein, we discuss the evidence for and against the potential for transfusion-transmission of leprosy, and highlight future areas of research to further elucidate this possibility.
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Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Brian D Adkins
- Department of Pathology, University of Texas Southwestern, Dallas, TX USA3, USA
| | - Lorin A Bibb
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, CA, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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Jacobs JW, Sharma D, Stephens LD, Figueroa Villalba CA, Rinder HM, Woo JS, Wheeler AP, Gerberi D, Goel R, Tormey CA, Booth GS, Bloch EM, Adkins BD. Thrombosis risk with haemoglobin C trait and haemoglobin C disease: A systematic review. Br J Haematol 2024; 204:1500-1506. [PMID: 38291731 DOI: 10.1111/bjh.19313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 02/01/2024]
Abstract
The thrombotic risk with haemoglobin C trait (HbAC) or haemoglobin C disease (HbCC) is unclear. However, individuals with HbCC have demonstrated chronic haemolysis, higher blood viscosity and altered rheology when compared to individuals with wild-type haemoglobin (HbAA). These physiological alterations may theoretically translate to increased risk of thrombosis; therefore, a systematic literature review was performed to investigate the possible association between HbAC and/or HbCC and thrombosis. Twenty-two studies met inclusion criteria representing 782 individuals with HbAC (n = 694) or HbCC (n = 88). Fifteen studies described the presence/absence of venous thromboembolism (VTE) in patients with HbAC (n = 685) or HbCC (n = 79), while seven studies described patients with HbAC (n = 9) or HbCC (n = 9) and arterial thrombosis. Most (n = 20) studies were case reports or case series; however, two studies suggested a potential increased VTE risk with HbAC compared to HbAA in (i) all patients (OR 2.2, 95% CI: 0.9-5.5) and in (ii) pregnant individuals (RR 3.7, 95% CI 0.9-16). This review is the largest assessment of patients with HbC trait or disease and thrombosis to date; despite its limitations, the findings suggest HbC may be a predisposing risk factor to thrombosis. Prospective cohort studies are warranted to definitively elucidate the risk of thrombosis in this population.
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Affiliation(s)
- Jeremy W Jacobs
- Special Coagulation Laboratory, Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Deva Sharma
- Division of Transfusion Medicine, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | | | - Henry M Rinder
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Hematology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, California, USA
| | - Allison P Wheeler
- Division of Coagulation Medicine, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Hematology/Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dana Gerberi
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota, USA
| | - Ruchika Goel
- Department of Internal Medicine, Simmons Cancer Institute, Southern Illinois University School of Medicine, Springfield, Illinois, USA
- Vitalant, Corporate Medical Affairs, Scottsdale, Arizona, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher A Tormey
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Garrett S Booth
- Division of Transfusion Medicine, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brian D Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Park HS, Yin A, Barranta C, Lee JS, Caputo CA, Sachithanandham J, Li M, Yoon S, Sitaras I, Jedlicka A, Eby Y, Ram M, Fernandez RE, Baker OR, Shenoy AG, Mosnaim GS, Fukuta Y, Patel B, Heath SL, Levine AC, Meisenberg BR, Spivak ES, Anjan S, Huaman MA, Blair JE, Currier JS, Paxton JH, Gerber JM, Petrini JR, Broderick PB, Rausch W, Cordisco ME, Hammel J, Greenblatt B, Cluzet VC, Cruser D, Oei K, Abinante M, Hammitt LL, Sutcliffe CG, Forthal DN, Zand MS, Cachay ER, Raval JS, Kassaye SG, Marshall CE, Yarava A, Lane K, McBee NA, Gawad AL, Karlen N, Singh A, Ford DE, Jabs DA, Appel LJ, Shade DM, Lau B, Ehrhardt S, Baksh SN, Shapiro JR, Ou J, Na YB, Knoll MD, Ornelas-Gatdula E, Arroyo-Curras N, Gniadek TJ, Caturegli P, Wu J, Ndahiro N, Betenbaugh MJ, Ziman A, Hanley DF, Casadevall A, Shoham S, Bloch EM, Gebo KA, Tobian AA, Laeyendecker O, Pekosz A, Klein SL, Sullivan DJ. Outpatient COVID-19 convalescent plasma recipient antibody thresholds correlated to reduced hospitalizations within a randomized trial. JCI Insight 2024; 9:e178460. [PMID: 38483534 DOI: 10.1172/jci.insight.178460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/06/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUNDCOVID-19 convalescent plasma (CCP) virus-specific antibody levels that translate into recipient posttransfusion antibody levels sufficient to prevent disease progression are not defined.METHODSThis secondary analysis correlated donor and recipient antibody levels to hospitalization risk among unvaccinated, seronegative CCP recipients within the outpatient, double-blind, randomized clinical trial that compared CCP to control plasma. The majority of COVID-19 CCP arm hospitalizations (15/17, 88%) occurred in this unvaccinated, seronegative subgroup. A functional cutoff to delineate recipient high versus low posttransfusion antibody levels was established by 2 methods: (i) analyzing virus neutralization-equivalent anti-Spike receptor-binding domain immunoglobulin G (anti-S-RBD IgG) responses in donors or (ii) receiver operating characteristic (ROC) curve analysis.RESULTSSARS-CoV-2 anti-S-RBD IgG antibody was volume diluted 21.3-fold into posttransfusion seronegative recipients from matched donor units. Virus-specific antibody delivered was approximately 1.2 mg. The high-antibody recipients transfused early (symptom onset within 5 days) had no hospitalizations. A CCP-recipient analysis for antibody thresholds correlated to reduced hospitalizations found a statistical significant association between early transfusion and high antibodies versus all other CCP recipients (or control plasma), with antibody cutoffs established by both methods-donor-based virus neutralization cutoffs in posttransfusion recipients (0/85 [0%] versus 15/276 [5.6%]; P = 0.03) or ROC-based cutoff (0/94 [0%] versus 15/267 [5.4%]; P = 0.01).CONCLUSIONIn unvaccinated, seronegative CCP recipients, early transfusion of plasma units in the upper 30% of study donors' antibody levels reduced outpatient hospitalizations. High antibody level plasma units, given early, should be reserved for therapeutic use.TRIAL REGISTRATIONClinicalTrials.gov NCT04373460.FUNDINGDepartment of Defense (W911QY2090012); Defense Health Agency; Bloomberg Philanthropies; the State of Maryland; NIH (3R01AI152078-01S1, U24TR001609-S3, 1K23HL151826NIH); the Mental Wellness Foundation; the Moriah Fund; Octapharma; the Healthnetwork Foundation; the Shear Family Foundation; the NorthShore Research Institute; and the Rice Foundation.
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Affiliation(s)
- Han-Sol Park
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anna Yin
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Caelan Barranta
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - John S Lee
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christopher A Caputo
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jaiprasath Sachithanandham
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Maggie Li
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Steve Yoon
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ioannis Sitaras
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anne Jedlicka
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yolanda Eby
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Malathi Ram
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Reinaldo E Fernandez
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Owen R Baker
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aarthi G Shenoy
- Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center, Washington DC, USA
| | - Giselle S Mosnaim
- Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Evanston, Illinois, USA
| | - Yuriko Fukuta
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Bela Patel
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - Sonya L Heath
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adam C Levine
- Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | | | - Emily S Spivak
- Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Shweta Anjan
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Moises A Huaman
- Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati, Ohio, USA
| | - Janis E Blair
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Judith S Currier
- Department of Medicine, Division of Infectious Diseases, UCLA, Los Angeles, California, USA
| | - James H Paxton
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Jonathan M Gerber
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | | | | | | | | | - Jean Hammel
- Nuvance Health Norwalk Hospital, Norwalk, Connecticut, USA
| | | | - Valerie C Cluzet
- Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, New York, USA
| | - Daniel Cruser
- Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, New York, USA
| | - Kevin Oei
- Ascada Research, Fullerton, California, USA
| | | | - Laura L Hammitt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Catherine G Sutcliffe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Donald N Forthal
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, California, USA
| | - Martin S Zand
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Edward R Cachay
- Department of Medicine, Division of Infectious Diseases, UCSD, San Diego, California, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Seble G Kassaye
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington DC, USA
| | - Christi E Marshall
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Karen Lane
- Department of Neurology, Brain Injury Outcomes
| | | | - Amy L Gawad
- Department of Neurology, Brain Injury Outcomes
| | | | - Atika Singh
- Department of Neurology, Brain Injury Outcomes
| | - Daniel E Ford
- Institute for Clinical and Translational Research, and
| | - Douglas A Jabs
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David M Shade
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stephan Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sheriza N Baksh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Janna R Shapiro
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jiangda Ou
- Department of Neurology, Brain Injury Outcomes
| | - Yu Bin Na
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Maria D Knoll
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elysse Ornelas-Gatdula
- Chemistry-Biology Interface Program, Zanvyl Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Netzahualcoyotl Arroyo-Curras
- Chemistry-Biology Interface Program, Zanvyl Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thomas J Gniadek
- Department of Pathology and Laboratory Medicine, Northshore University Health System, Evanston, Illinois, USA
| | - Patrizio Caturegli
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jinke Wu
- Advanced Mammalian Biomanufacturing Innovation Center, Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nelson Ndahiro
- Advanced Mammalian Biomanufacturing Innovation Center, Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael J Betenbaugh
- Advanced Mammalian Biomanufacturing Innovation Center, Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alyssa Ziman
- Department of Pathology and Laboratory Medicine, Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | | | - Arturo Casadevall
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly A Gebo
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron Ar Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases (NIAID), Baltimore, Maryland, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David J Sullivan
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Jacobs JW, Adkins BD, Bibb LA, Woo JS, Allen ES, Stephens LD, Binns TC, Bloch EM, Booth GS. The potential association between extracorporeal photopheresis and thrombosis. Bone Marrow Transplant 2024; 59:270-273. [PMID: 37996561 DOI: 10.1038/s41409-023-02153-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 10/30/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Brian D Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lorin A Bibb
- Department of Dermatology, Mayo Clinic, Rocester, MN, USA
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, CA, USA
| | - Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Thomas C Binns
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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Huso T, Buban K, Van Denakker TA, Haddaway K, Smetana H, Marshall C, Rai H, Ness PM, Bloch EM, Tobian AAR, Crowe EP. Reevaluation of the medical necessity of washed red blood cell transfusion in chronically transfused adults. Transfusion 2024; 64:216-222. [PMID: 38130071 DOI: 10.1111/trf.17690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Washing red blood cell (RBC) units mitigates severe allergic transfusion reactions. However, washing reduces the time to expiration and the effective dose. Automated washing is time- and labor-intensive. A shortage of cell processor tubing sets prompted review of medical necessity for washed RBC for patients previously thought to require washing. STUDY DESIGN AND METHODS A single-center, retrospective study investigated discontinuing wash RBC protocols in chronically transfused adults. In select patients with prior requirements for washing, due to a history of allergic transfusion reactions, trials of unwashed transfusions were performed. Patient demographic, clinical, laboratory, and transfusion data were compiled. The per-unit washing cost was the sum of the tubing set, saline, and technical labor costs. RESULTS Fifteen patients (median age 34 years interquartile range [IQR] 23-53 years, 46.7% female) were evaluated. These patients had been transfused with a median of 531 washed RBC units (IQR 244-1066) per patient over 12 years (IQR 5-18 years), most commonly for recurrent, non-severe allergic reactions. There were no transfusion reactions with unwashed RBCs aside from one patient with one episode of pruritus and another with recurrent pruritus, which was typical even with washed RBC. We decreased the mean number of washed RBC units per month by 72.9% (104 ± 10 vs. 28.2 ± 25.2; p < .0001) and saved US $100.25 per RBC unit. CONCLUSION Washing of RBCs may be safely reconsidered in chronically transfused patients without a history of anaphylaxis. Washing should be implemented judiciously due to potential lack of necessity and logistical/operational challenges.
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Affiliation(s)
- Tait Huso
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kristen Buban
- Division of Transfusion Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Tayler A Van Denakker
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pathology and Laboratory Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kathy Haddaway
- Division of Transfusion Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Heather Smetana
- Division of Transfusion Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Christi Marshall
- Division of Transfusion Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Herleen Rai
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul M Ness
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth P Crowe
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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7
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Gebo KA, Heath SL, Fukuta Y, Zhu X, Baksh S, Abraham AG, Habtehyimer F, Shade D, Ruff J, Ram M, Laeyendecker O, Fernandez RE, Patel EU, Baker OR, Shoham S, Cachay ER, Currier JS, Gerber JM, Meisenberg B, Forthal DN, Hammitt LL, Huaman MA, Levine A, Mosnaim GS, Patel B, Paxton JH, Raval JS, Sutcliffe CG, Anjan S, Gniadek T, Kassaye S, Blair JE, Lane K, McBee NA, Gawad AL, Das P, Klein SL, Pekosz A, Bloch EM, Hanley D, Casadevall A, Tobian AAR, Sullivan DJ. Erratum for Gebo et al., "Early antibody treatment, inflammation, and risk of post-COVID conditions". mBio 2024; 15:e0297923. [PMID: 38095433 PMCID: PMC10790766 DOI: 10.1128/mbio.02979-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
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8
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Habtehyimer F, Zhu X, Redd AD, Gebo KA, Abraham AG, Patel EU, Laeyendecker O, Gniadek TJ, Fernandez RE, Baker OR, Ram M, Cachay ER, Currier JS, Fukuta Y, Gerber JM, Heath SL, Meisenberg B, Huaman MA, Levine AC, Shenoy A, Anjan S, Blair JE, Cruser D, Forthal DN, Hammitt LL, Kassaye S, Mosnaim GS, Patel B, Paxton JH, Raval JS, Sutcliffe CG, Abinante M, Oei KS, Cluzet V, Cordisco ME, Greenblatt B, Rausch W, Shade D, Gawad AL, Klein SL, Pekosz A, Shoham S, Casadevall A, Bloch EM, Hanley D, Tobian AAR, Sullivan DJ. COVID-19 convalescent plasma therapy decreases inflammatory cytokines: a randomized controlled trial. Microbiol Spectr 2024; 12:e0328623. [PMID: 38009954 PMCID: PMC10783116 DOI: 10.1128/spectrum.03286-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/25/2023] [Indexed: 11/29/2023] Open
Abstract
IMPORTANCE This study examined the role that cytokines may have played in the beneficial outcomes found when outpatient individuals infected with SARS-CoV-2 were transfused with COVID-19 convalescent plasma (CCP) early in their infection. We found that the pro-inflammatory cytokine IL-6 decreased significantly faster in patients treated early with CCP. Participants with COVID-19 treated with CCP later in the infection did not have the same effect. This decrease in IL-6 levels after early CCP treatment suggests a possible role of inflammation in COVID-19 progression. The evidence of IL-6 involvement brings insight into the possible mechanisms involved in CCP treatment mitigating SARS-CoV-2 severity.
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Affiliation(s)
- Feben Habtehyimer
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Xianming Zhu
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andrew D. Redd
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, USA
| | - Kelly A. Gebo
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alison G. Abraham
- Department of Epidemiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Eshan U. Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, USA
| | - Thomas J. Gniadek
- Department of Pathology and Laboratory Medicine, Northshore University Health System, Evanston, Illinois, USA
| | - Reinaldo E. Fernandez
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Owen R. Baker
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Malathi Ram
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Edward R. Cachay
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, California, USA
| | - Judith S. Currier
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, California, USA
| | - Yuriko Fukuta
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Jonathan M. Gerber
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Sonya L. Heath
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Barry Meisenberg
- Department of Medicine and Research Institute of Luminis Health, Annapolis, Maryland, USA
| | - Moises A. Huaman
- Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati, Ohio, USA
| | - Adam C. Levine
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Aarthi Shenoy
- Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Shweta Anjan
- Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Janis E. Blair
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Daniel Cruser
- Department of Pathology, Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, New York, USA
| | - Donald N. Forthal
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, California, USA
| | - Laura L. Hammitt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Seble Kassaye
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
| | - Giselle S. Mosnaim
- Department of Medicine, Division of Allergy and Immunology, Northshore University Health System, Evanston, Illinois, USA
| | - Bela Patel
- Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - James H. Paxton
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA
| | - Jay S. Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Catherine G. Sutcliffe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Valerie Cluzet
- Department of Infectious Disease, Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, New York, USA
| | | | | | - William Rausch
- Nuvance Health Danbury Hospital, Danbury, Connecticut, USA
| | - David Shade
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Amy L. Gawad
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sabra L. Klein
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andrew Pekosz
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Evan M. Bloch
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Daniel Hanley
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Aaron A. R. Tobian
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - David J. Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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9
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Mercure-Corriveau N, Crowe EP, Vozniak S, Feng X, Rai H, Van Denakker T, Zakieh A, Grabowski MK, Lanzkron S, Tobian AAR, Bloch EM. Euvolemic automated transfusion to treat severe anemia in sickle cell disease patients at risk of circulatory overload. Transfusion 2024; 64:124-131. [PMID: 38069526 PMCID: PMC10841671 DOI: 10.1111/trf.17613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Red blood cell (RBC) transfusion remains a major treatment for sickle cell disease (SCD). Patients with SCD have a high prevalence of renal impairment and cardiorespiratory disease, conferring risk of transfusion-associated circulatory overload (TACO). STUDY DESIGN AND METHODS We describe an approach, titled euvolemic automated transfusion (EAT), to transfuse SCD patients with severe anemia who are at risk of TACO. In EAT, plasmapheresis is performed using donor RBCs, rather than albumin or plasma, as replacement fluid. Euvolemia is maintained. A retrospective analysis was conducted of patients with SCD who underwent EAT at our institution over a 10-year period, to evaluate the efficacy and safety of EAT. RESULTS Eleven SCD patients underwent 109 EAT procedures (1-59 procedures per patient). The median age was 42 years (IQR = [30-49]) and 82% (n = 9) were female. Most (82%; n = 9) patients had severe chronic kidney disease and 55% (n = 6) had heart failure. One (9%) patient had a history of life-threatening TACO. Mean pre- and post-procedure Hct values were 19.8% (SD ± 1.6%) and 29.1% (SD ± 1.4%), respectively. The average Hct increment was 3.2% per RBC unit. Only two EAT-related complications were recorded during the 109 procedures: central line-associated infection and citrate toxicity (muscle cramping). EAT used an average of two RBC units less than that projected for standard automated RBC exchange. CONCLUSION Our findings suggest that EAT is safe and effective to treat patients with SCD and severe anemia, who are at risk for TACO. EAT requires fewer RBC units compared to automated RBC exchange.
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Affiliation(s)
- Nicolas Mercure-Corriveau
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth P Crowe
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sonja Vozniak
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Xinyi Feng
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Herleen Rai
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tayler Van Denakker
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Abdulhafiz Zakieh
- Division of Hematology-Oncology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - M Kate Grabowski
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sophie Lanzkron
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Evan M Bloch
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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10
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Bloch EM, Tobian AAR. Optimizing Blood Transfusion in Patients with Acute Myocardial Infarction. N Engl J Med 2023; 389:2483-2485. [PMID: 38157506 DOI: 10.1056/nejme2312741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
- Evan M Bloch
- From the Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore
| | - Aaron A R Tobian
- From the Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore
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11
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Park HS, Yin A, Barranta C, Lee JS, Caputo CA, Sachithanandham J, Li M, Yoon S, Sitaras I, Jedlicka A, Eby Y, Ram M, Fernandez RE, Baker OR, Shenoy AG, Mosnaim GS, Fukuta Y, Patel B, Heath SL, Levine AC, Meisenberg BR, Spivak ES, Anjan S, Huaman MA, Blair JE, Currier JS, Paxton JH, Gerber JM, Petrini JR, Broderick PB, Rausch W, Cordisco ME, Hammel J, Greenblatt B, Cluzet VC, Cruser D, Oei K, Abinante M, Hammitt LL, Sutcliffe CG, Forthal DN, Zand MS, Cachay ER, Raval JS, Kassaye SG, Marshall CE, Yarava A, Lane K, McBee NA, Gawad AL, Karlen N, Singh A, Ford DE, Jabs DA, Appel LJ, Shade DM, Lau B, Ehrhardt S, Baksh SN, Shapiro JR, Ou J, Na YB, Knoll MD, Ornelas-Gatdula E, Arroyo-Curras N, Gniadek TJ, Caturegli P, Wu J, Ndahiro N, Betenbaugh MJ, Ziman A, Hanley DF, Casadevall A, Shoham S, Bloch EM, Gebo KA, Tobian AAR, Laeyendecker O, Pekosz A, Klein SL, Sullivan DJ. Outpatient COVID-19 convalescent plasma recipient antibody thresholds correlated to reduced hospitalizations within a randomized trial. medRxiv 2023:2023.04.13.23288353. [PMID: 37131659 PMCID: PMC10153328 DOI: 10.1101/2023.04.13.23288353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND The COVID-19 convalescent plasma (CCP) viral specific antibody levels that translate into recipient post-transfusion antibody levels sufficient to prevent disease progression is not defined. METHODS This secondary analysis correlated donor and recipient antibody levels to hospitalization risk among unvaccinated, seronegative CCP recipients within the outpatient, double blind, randomized clinical trial that compared CCP to control plasma. The majority of COVID-19 CCP arm hospitalizations (15/17, 88%) occurred in this unvaccinated, seronegative subgroup. A functional cutoff to delineate recipient high versus low post-transfusion antibody levels was established by two methods: 1) analyzing virus neutralization-equivalent anti-S-RBD IgG responses in donors or 2) receiver operating characteristic (ROC) analysis. RESULTS SARS-CoV-2 anti-S-RBD IgG antibody was diluted by a factor of 21.3 into post-transfusion seronegative recipients from matched donor units. Viral specific antibody delivered approximated 1.2 mg. The high antibody recipients transfused early (symptom onset within 5 days) had no hospitalizations. A CCP recipient analysis for antibody thresholds correlated to reduced hospitalizations found a significant association with Fisher's exact test between early and high antibodies versus all other CCP recipients (or control plasma) with antibody cutoffs established by both methods-donor virus neutralization-based cutoff: (0/85; 0% versus 15/276; 5.6%) p=0.03 or ROC based cutoff: (0/94; 0% versus 15/267; 5.4%) p=0.01. CONCLUSION In unvaccinated, seronegative CCP recipients, early transfusion of plasma units corresponding to the upper 30% of all study donors reduced outpatient hospitalizations. These high antibody level plasma units, given early, should be reserved for therapeutic use.Trial registration: NCT04373460. FUNDING Defense Health Agency and others.
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Affiliation(s)
- Han-Sol Park
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anna Yin
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caelan Barranta
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John S Lee
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christopher A Caputo
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jaiprasath Sachithanandham
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maggie Li
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Steve Yoon
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ioannis Sitaras
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anne Jedlicka
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yolanda Eby
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Malathi Ram
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Reinaldo E Fernandez
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Owen R Baker
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aarthi G Shenoy
- Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center, Washington DC, USA
| | - Giselle S Mosnaim
- Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Evanston, IL, USA
| | - Yuriko Fukuta
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
| | - Bela Patel
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Sonya L Heath
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adam C Levine
- Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI, USA
| | | | - Emily S Spivak
- Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Shweta Anjan
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Moises A Huaman
- Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati, OH, USA
| | - Janis E Blair
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Judith S Currier
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, CA, USA
| | - James H Paxton
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jonathan M Gerber
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | | | | | | | - Jean Hammel
- Nuvance Health Norwalk Hospital, Norwalk, CT, USA
| | | | - Valerie C Cluzet
- Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY, USA
| | - Daniel Cruser
- Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY, USA
| | | | | | - Laura L Hammitt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catherine G Sutcliffe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Donald N Forthal
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, CA, USA
| | - Martin S Zand
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Edward R Cachay
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, CA, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Seble G Kassaye
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center Washington DC, USA
| | - Christi E Marshall
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anusha Yarava
- Department of Neurology, Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karen Lane
- Department of Neurology, Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nichol A McBee
- Department of Neurology, Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy L Gawad
- Department of Neurology, Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicky Karlen
- Department of Neurology, Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Atika Singh
- Department of Neurology, Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel E Ford
- Institute for Clinical and Translational Research Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Douglas A Jabs
- Department of Ophthalmology Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David M Shade
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephan Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sheriza N Baksh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Janna R Shapiro
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jiangda Ou
- Department of Neurology, Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yu Bin Na
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maria D Knoll
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elysse Ornelas-Gatdula
- Chemistry-Biology Interface Program, Zanvyl Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore MD, USA
| | - Netzahualcoyotl Arroyo-Curras
- Chemistry-Biology Interface Program, Zanvyl Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore MD, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas J Gniadek
- Department of Pathology and Laboratory Medicine, Northshore University Health System, Evanston, IL
| | - Patrizio Caturegli
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jinke Wu
- Advanced Mammalian Biomanufacturing Innovation Center, Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Nelson Ndahiro
- Advanced Mammalian Biomanufacturing Innovation Center, Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Michael J Betenbaugh
- Advanced Mammalian Biomanufacturing Innovation Center, Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Alyssa Ziman
- Department of Pathology and Laboratory Medicine, Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Daniel F Hanley
- Department of Neurology, Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Arturo Casadevall
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly A Gebo
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore, MD, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David J Sullivan
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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12
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Gebo KA, Heath SL, Fukuta Y, Zhu X, Baksh S, Abraham AG, Habtehyimer F, Shade D, Ruff J, Ram M, Laeyendecker O, Fernandez RE, Patel EU, Baker OR, Shoham S, Cachay ER, Currier JS, Gerber JM, Meisenberg B, Forthal DN, Hammitt LL, Huaman MA, Levine A, Mosnaim GS, Patel B, Paxton JH, Raval JS, Sutcliffe CG, Anjan S, Gniadek T, Kassaye S, Blair JE, Lane K, McBee NA, Gawad AL, Das P, Klein SL, Pekosz A, Bloch EM, Hanley D, Casadevall A, Tobian AAR, Sullivan DJ. Early antibody treatment, inflammation, and risk of post-COVID conditions. mBio 2023; 14:e0061823. [PMID: 37724870 PMCID: PMC10653913 DOI: 10.1128/mbio.00618-23] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/02/2023] [Indexed: 09/21/2023] Open
Abstract
IMPORTANCE Approximately 20% of individuals infected with SARS-CoV-2 experienced long-term health effects, as defined PCC. However, it is unknown if there are any early biomarkers associated with PCC or whether early intervention treatments may decrease the risk of PCC. In a secondary analysis of a randomized clinical trial, this study demonstrates that among outpatients with SARS-CoV-2, increased IL-6 at time of infection is associated with increased odds of PCC. In addition, among individuals treated early, within 5 days of symptom onset, with COVID-19 convalescent plasma, there was a trend for decreased odds of PCC after adjusting for other demographic and clinical characteristics. Future treatment studies should be considered to evaluate the effect of early treatment and anti-IL-6 therapies on PCC development.
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Affiliation(s)
- Kelly A. Gebo
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sonya L. Heath
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yuriko Fukuta
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Xianming Zhu
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sheriza Baksh
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Allison G. Abraham
- Department of Epidemiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Feben Habtehyimer
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Shade
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jessica Ruff
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Malathi Ram
- Departement of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Baltimore, Maryland, USA
| | - Reinaldo E. Fernandez
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eshan U. Patel
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Owen R. Baker
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Edward R. Cachay
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, California, USA
| | - Judith S. Currier
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, California, USA
| | - Jonathan M. Gerber
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worchester, Massachusetts, USA
| | | | - Donald N. Forthal
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, California, USA
| | - Laura L. Hammitt
- Departement of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Moises A. Huaman
- Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati, Ohio, USA
| | - Adam Levine
- Department of Emergency Medicine, Rhode Island Hospital Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Giselle S. Mosnaim
- Department of Medicine, Division of Allergy and Immunology, Northshore University Health System, Evanston, Illinois, USA
| | - Bela Patel
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - James H. Paxton
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA
| | - Jay S. Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Catherine G. Sutcliffe
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Departement of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shweta Anjan
- Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Thomas Gniadek
- Department of Pathology, Northshore University Health System, Evanston, Illinois, USA
| | - Seble Kassaye
- Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Janis E. Blair
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Karen Lane
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nichol A. McBee
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amy L. Gawad
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Piyali Das
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sabra L. Klein
- Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew Pekosz
- Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Evan M. Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel Hanley
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aaron A. R. Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David J. Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - on behalf of the CSSC-004 Consortium
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Departement of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Baltimore, Maryland, USA
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, California, USA
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, California, USA
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worchester, Massachusetts, USA
- Luminis Health, Annapolis, Maryland, USA
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, California, USA
- Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati, Ohio, USA
- Department of Emergency Medicine, Rhode Island Hospital Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Medicine, Division of Allergy and Immunology, Northshore University Health System, Evanston, Illinois, USA
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, Texas, USA
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, Florida, USA
- Department of Pathology, Northshore University Health System, Evanston, Illinois, USA
- Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, DC, USA
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona, USA
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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13
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Drews SJ, Kjemtrup AM, Krause PJ, Lambert G, Leiby DA, Lewin A, O'Brien SF, Renaud C, Tonnetti L, Bloch EM. Transfusion-transmitted Babesia spp.: a changing landscape of epidemiology, regulation, and risk mitigation. J Clin Microbiol 2023; 61:e0126822. [PMID: 37750699 PMCID: PMC10595070 DOI: 10.1128/jcm.01268-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
Babesia spp. are tick-borne parasites with a global distribution and diversity of vertebrate hosts. Over the next several decades, climate change is expected to impact humans, vectors, and vertebrate hosts and change the epidemiology of Babesia. Although humans are dead-end hosts for tick-transmitted Babesia, human-to-human transmission of Babesia spp. from transfusion of red blood cells and whole blood-derived platelet concentrates has been reported. In most patients, transfusion-transmitted Babesia (TTB) results in a moderate-to-severe illness. Currently, in North America, most cases of TTB have been described in the United States. TTB cases outside North America are rare, but case numbers may change over time with increased recognition of babesiosis and as the epidemiology of Babesia is impacted by climate change. Therefore, TTB is a concern of microbiologists working in blood operator settings, as well as in clinical settings where transfusion occurs. Microbiologists play an important role in deploying blood donor screening assays in Babesia endemic regions, identifying changing risks for Babesia in non-endemic areas, investigating recipients of blood products for TTB, and drafting TTB policies and guidelines. In this review, we provide an overview of the clinical presentation and epidemiology of TTB. We identify approaches and technologies to reduce the risk of collecting blood products from Babesia-infected donors and describe how investigations of TTB are undertaken. We also describe how microbiologists in Babesia non-endemic regions can assess for changing risks of TTB and decide when to focus on laboratory-test-based approaches or pathogen reduction to reduce TTB risk.
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Affiliation(s)
- Steven J. Drews
- Microbiology, Donation Policy and Studies, Canadian Blood Services, Edmonton, Alberta, Canada
- Department of Laboratory Medicine and Pathology, Division of Diagnostic and Applied Microbiology, University of Alberta, Edmonton, Alberta, Canada
| | - Anne M. Kjemtrup
- California Department of Public Health, Vector-Borne Disease Section, Sacramento, California, USA
| | - Peter J. Krause
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health and Yale School of Medicine, New Haven, Connecticut, USA
| | - Grayson Lambert
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health and Yale School of Medicine, New Haven, Connecticut, USA
| | - David A. Leiby
- Department of Microbiology, Immunology, and Tropical Medicine, George Washington University, Washington, USA
| | - Antoine Lewin
- Epidemiology, Surveillance and Biological Risk Assessment, Medical Affairs and Innovation, Héma-Québec, Montréal, Quebec, Canada
- Département d'Obstétrique et de Gynécologie, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Sheila F. O'Brien
- Epidemiology and Surveillance, Canadian Blood Services, Donation Policy and Studies, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Christian Renaud
- Department of Microbiology, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Laura Tonnetti
- American Red Cross, Scientific Affairs, Holland Laboratories for the Biomedical Sciences, Rockville, Maryland, USA
| | - Evan M. Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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14
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Jacobs JW, Stephens LD, Milner DA, Bloch EM, Goel R, Tobian AAR, Shibemba AL, Eichbaum Q. Survey of blood collection and transfusion practices among institutions in Africa. Transfusion 2023; 63:1849-1858. [PMID: 37646070 DOI: 10.1111/trf.17501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/01/2023] [Accepted: 07/07/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Dramatic improvements in blood transfusion have occurred during the last two decades. Transfusion medicine services and practices in Africa remain underexplored. METHODS A survey of blood bank/transfusion medicine (BBTM) practices, available blood products, blood product source(s), pre-transfusion testing, and blood donor infectious disease testing methodologies across Africa was performed using the American Society for Clinical Pathology (ASCP) listserv. Survey recipients included hospital-based laboratories/blood banks, national transfusion medicine services, and free-standing laboratories (collectively referred to as institutions). RESULTS Responses from a total of 81 institutions across 22 countries were analyzed. All 81 institutions provide at least one type of blood product-whole blood, red blood cells (RBCs), platelets, plasma, and cryoprecipitate, with whole blood (90.1%, 73 of 81) and RBCs (79.0%, 64 of 81) most common, while cryoprecipitate is least common (12.4%, 10 of 81). Only five countries had a responding institution that provides all types of products. Among institutions that collect blood onsite, the most common sources of blood products are patients' family members (94.1%, 48 of 51) and pre-screened on-demand volunteer donors (82.4%, 42 of 51). The most commonly screened infectious agents are HIV and hepatitis B virus (both 81.5%), while 70.4% (57 of 81) test for hepatitis C virus (HCV) and Treponema pallidum. DISCUSSION This study highlights significant variability and restrictions in blood product availability, pre-transfusion testing, and blood donor infectious disease testing across Africa. Further studies are needed to ascertain barriers to improving blood donor availability, blood product safety, and infectious disease testing.
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Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Danny A Milner
- American Society for Clinical Pathology, Chicago, Illinois, USA
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ruchika Goel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Departments of Internal Medicine and Pediatrics, Simmons Cancer Institute at SIU School of Medicine, Springfield, Illinois, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron Lunda Shibemba
- Department of Pathology and Microbiology, University Teaching Hospital, Lusaka, Zambia
| | - Quentin Eichbaum
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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15
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Bloch EM, Busch MP, Corash LM, Dodd R, Hailu B, Kleinman S, O'Brien S, Petersen L, Stramer SL, Katz L. Leveraging Donor Populations to Study the Epidemiology and Pathogenesis of Transfusion-Transmitted and Emerging Infectious Diseases. Transfus Med Rev 2023; 37:150769. [PMID: 37919210 PMCID: PMC10841704 DOI: 10.1016/j.tmrv.2023.150769] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 11/04/2023]
Abstract
The tragedy of transfusion-associated hepatitis and HIV spurred a decades-long overhaul of the regulatory oversight and practice of blood transfusion. Consequent to improved donor selection, testing, process control, clinical transfusion practice and post-transfusion surveillance, transfusion in the United States and other high-income countries is now a very safe medical procedure. Nonetheless, pathogens continue to emerge and threaten the blood supply, highlighting the need for a proactive approach to blood transfusion safety. Blood donor populations and the global transfusion infrastructure are under-utilized resources for the study of infectious diseases. Blood donors are large, demographically diverse subsets of general populations for whom cross-sectional and longitudinal samples are readily accessible for serological and molecular testing. Blood donor collection networks span diverse geographies, including in low- and middle-income countries, where agents, especially zoonotic pathogens, are able to emerge and spread, given limited tools for recognition, surveillance and control. Routine laboratory storage and transportation, coupled with data capture, afford access to rich epidemiological data to assess the epidemiology and pathogenesis of established and emerging infections. Subsequent to the State of the Science in Transfusion Medicine symposium in 2022, our working group (WG), "Emerging Infections: Impact on Blood Science, the Blood Supply, Blood Safety, and Public Health" elected to focus on "leveraging donor populations to study the epidemiology and pathogenesis of transfusion-transmitted and emerging infectious diseases." The 5 landmark studies span (1) the implication of hepatitis C virus in post-transfusion hepatitis, (2) longitudinal evaluation of plasma donors with incident infections, thus informing the development of a widely used staging system for acute HIV infection, (3) explication of the dynamics of early West Nile Virus infection, (4) the deployment of combined molecular and serological donor screening for Babesia microti, to characterize its epidemiology and infectivity and facilitate routine donor screening, and (5) national serosurveillance for SARS-CoV-2 during the COVID-19 pandemic. The studies highlight the interplay between infectious diseases and transfusion medicine, including the imperative to ensure blood transfusion safety and the broader application of blood donor populations to the study of infectious diseases.
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Affiliation(s)
- Evan M Bloch
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, MD, USA.
| | - Michael P Busch
- Vitalant Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Laurence M Corash
- Cerus Corporation, Concord, CA, USA; Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Roger Dodd
- Scientific Affairs, American Red Cross, Gaithersburg, MD, USA
| | - Benyam Hailu
- Division of Blood Diseases Research, National Heart Lung and Blood Institute, Bethesda, MD, USA
| | | | - Sheila O'Brien
- Canadian Blood Services, Epidemiology and Surveillance, Microbiology, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Lyle Petersen
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Fort Collins, Colorado, USA
| | - Susan L Stramer
- Scientific Affairs, American Red Cross, Gaithersburg, MD, USA
| | - Louis Katz
- ImpactLife Blood Services, Davenport, IA, USA
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16
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Senefeld JW, Gorman EK, Johnson PW, Moir ME, Klassen SA, Carter RE, Paneth NS, Sullivan DJ, Morkeberg OH, Wright RS, Fairweather D, Bruno KA, Shoham S, Bloch EM, Focosi D, Henderson JP, Juskewitch JE, Pirofski LA, Grossman BJ, Tobian AA, Franchini M, Ganesh R, Hurt RT, Kay NE, Parikh SA, Baker SE, Buchholtz ZA, Buras MR, Clayburn AJ, Dennis JJ, Diaz Soto JC, Herasevich V, Klompas AM, Kunze KL, Larson KF, Mills JR, Regimbal RJ, Ripoll JG, Sexton MA, Shepherd JR, Stubbs JR, Theel ES, van Buskirk CM, van Helmond N, Vogt MN, Whelan ER, Wiggins CC, Winters JL, Casadevall A, Joyner MJ. Rates Among Hospitalized Patients With COVID-19 Treated With Convalescent Plasma: A Systematic Review and Meta-Analysis. Mayo Clin Proc Innov Qual Outcomes 2023; 7:499-513. [PMID: 37859995 PMCID: PMC10582279 DOI: 10.1016/j.mayocpiqo.2023.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Objective To examine the association of COVID-19 convalescent plasma transfusion with mortality and the differences between subgroups in hospitalized patients with COVID-19. Patients and Methods On October 26, 2022, a systematic search was performed for clinical studies of COVID-19 convalescent plasma in the literature from January 1, 2020, to October 26, 2022. Randomized clinical trials and matched cohort studies investigating COVID-19 convalescent plasma transfusion compared with standard of care treatment or placebo among hospitalized patients with confirmed COVID-19 were included. The electronic search yielded 3841 unique records, of which 744 were considered for full-text screening. The selection process was performed independently by a panel of 5 reviewers. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were extracted by 5 independent reviewers in duplicate and pooled using an inverse-variance random effects model. The prespecified end point was all-cause mortality during hospitalization. Results Thirty-nine randomized clinical trials enrolling 21,529 participants and 70 matched cohort studies enrolling 50,160 participants were included in the systematic review. Separate meta-analyses reported that transfusion of COVID-19 convalescent plasma was associated with a decrease in mortality compared with the control cohort for both randomized clinical trials (odds ratio [OR], 0.87; 95% CI, 0.76-1.00) and matched cohort studies (OR, 0.76; 95% CI, 0.66-0.88). The meta-analysis of subgroups revealed 2 important findings. First, treatment with convalescent plasma containing high antibody levels was associated with a decrease in mortality compared with convalescent plasma containing low antibody levels (OR, 0.85; 95% CI, 0.73 to 0.99). Second, earlier treatment with COVID-19 convalescent plasma was associated with a decrease in mortality compared with the later treatment cohort (OR, 0.63; 95% CI, 0.48 to 0.82). Conclusion During COVID-19 convalescent plasma use was associated with a 13% reduced risk of mortality, implying a mortality benefit for hospitalized patients with COVID-19, particularly those treated with convalescent plasma containing high antibody levels treated earlier in the disease course.
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Affiliation(s)
- Jonathon W. Senefeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL
| | - Ellen K. Gorman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Patrick W. Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - M. Erin Moir
- Department of Kinesiology, University of Wisconsin-Madison, Madison
| | - Stephen A. Klassen
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada
| | - Rickey E. Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - Nigel S. Paneth
- Department of Epidemiology and Biostatistics and Department of Pediatrics and Human Development, Michigan State University, East Lansing
| | - David J. Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, ML
| | - Olaf H. Morkeberg
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - R. Scott Wright
- Human Research Protection Program, Mayo Clinic, Rochester, MN
| | | | - Katelyn A. Bruno
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Division of Cardiovascular Medicine, University of Florida, Gainesville
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Evan M. Bloch
- Department of Pathology Johns Hopkins University School of Medicine, Baltimore, ML
| | - Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, Italy
| | - Jeffrey P. Henderson
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St. Louis, MO
- Department of Molecular Microbiology, Washington University School of Medicine in St. Louis, MO
| | | | - Liise-Anne Pirofski
- Division of Infectious Diseases, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Brenda J. Grossman
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, MO
| | - Aaron A.R. Tobian
- Department of Pathology Johns Hopkins University School of Medicine, Baltimore, ML
| | - Massimo Franchini
- Division of Transfusion Medicine, Carlo Poma Hospital, Mantua, Italy
| | - Ravindra Ganesh
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Ryan T. Hurt
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Neil E. Kay
- Division of Hematology, Mayo Clinic, Rochester, MN
- Department of Immunology, Mayo Clinic, Rochester, MN
| | | | - Sarah E. Baker
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Zachary A. Buchholtz
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Matthew R. Buras
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ
| | - Andrew J. Clayburn
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Joshua J. Dennis
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Juan C. Diaz Soto
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Allan M. Klompas
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Katie L. Kunze
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ
| | | | - John R. Mills
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Riley J. Regimbal
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Juan G. Ripoll
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Matthew A. Sexton
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - John R.A. Shepherd
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - James R. Stubbs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Elitza S. Theel
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Noud van Helmond
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Matthew N.P. Vogt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Emily R. Whelan
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Chad C. Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Jeffrey L. Winters
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, ML
| | - Michael J. Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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17
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Stephens LD, Allen ES, Bloch EM, Crowe EP, Campbell-Lee SA, Booth GS, Kopko P. How do we ensure a safe ABO recheck process? Transfusion 2023; 63:1789-1796. [PMID: 37660311 DOI: 10.1111/trf.17530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/16/2023] [Accepted: 07/16/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Collecting a patient's blood in a correctly labeled pretransfusion specimen tube is essential for accurate ABO typing and safe transfusion. Noncompliance with specimen collection procedures can lead to wrong blood in tube (WBIT) incidents with potentially fatal consequences. Recent WBIT events inspired the investigation of how various institutions currently reduce the risk of these errors and ensure accurate ABO typing of patient samples. MATERIALS AND METHODS This article describes the techniques employed at various institutions across the United States to mitigate the risk of misidentified pretransfusion patient specimens. Details and considerations for each of these measures are provided. RESULTS Several institutions require the order for an ABO confirmation specimen, if indicated, to be generated from the transfusion medicine (TM) laboratory. Others issue a dedicated collection tube that is available exclusively from the TM service. Many institutions employ barcoding for electronic positive patient identification. Some use a combination of these strategies, depending on the locations or service lines from which the specimens are collected. CONCLUSION The description of various WBIT mitigation strategies will inform TM services on practices that may be effective at their respective institutions. Irrespective of the method(s) utilized, institutions should continue to monitor and mitigate specimen misidentification errors to promote sustained safe transfusion practices.
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Affiliation(s)
- Laura D Stephens
- University of California San Diego Health, La Jolla, California, USA
| | - Elizabeth S Allen
- University of California San Diego Health, La Jolla, California, USA
| | - Evan M Bloch
- Johns Hopkins University School of Medicine Baltimore, Baltimore, Maryland, USA
| | - Elizabeth P Crowe
- Johns Hopkins University School of Medicine Baltimore, Baltimore, Maryland, USA
| | | | - Garrett S Booth
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Patricia Kopko
- University of California San Diego Health, La Jolla, California, USA
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18
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Zhu X, Gebo KA, Abraham AG, Habtehyimer F, Patel EU, Laeyendecker O, Gniadek TJ, Fernandez RE, Baker OR, Ram M, Cachay ER, Currier JS, Fukuta Y, Gerber JM, Heath SL, Meisenberg B, Huaman MA, Levine AC, Shenoy A, Anjan S, Blair JE, Cruser D, Forthal DN, Hammitt LL, Kassaye S, Mosnaim GS, Patel B, Paxton JH, Raval JS, Sutcliffe CG, Abinante M, Broderick P, Cluzet V, Cordisco ME, Greenblatt B, Petrini J, Rausch W, Shade D, Lane K, Gawad AL, Klein SL, Pekosz A, Shoham S, Casadevall A, Bloch EM, Hanley D, Sullivan DJ, Tobian AAR. Dynamics of inflammatory responses after SARS-CoV-2 infection by vaccination status in the USA: a prospective cohort study. Lancet Microbe 2023; 4:e692-e703. [PMID: 37659419 PMCID: PMC10475695 DOI: 10.1016/s2666-5247(23)00171-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Cytokines and chemokines play a critical role in the response to infection and vaccination. We aimed to assess the longitudinal association of COVID-19 vaccination with cytokine and chemokine concentrations and trajectories among people with SARS-CoV-2 infection. METHODS In this longitudinal, prospective cohort study, blood samples were used from participants enrolled in a multi-centre randomised trial assessing the efficacy of convalescent plasma therapy for ambulatory COVID-19. The trial was conducted in 23 outpatient sites in the USA. In this study, participants (aged ≥18 years) were restricted to those with COVID-19 before vaccination or with breakthrough infections who had blood samples and symptom data collected at screening (pre-transfusion), day 14, and day 90 visits. Associations between COVID-19 vaccination status and concentrations of 21 cytokines and chemokines (measured using multiplexed sandwich immunoassays) were examined using multivariate linear mixed-effects regression models, adjusted for age, sex, BMI, hypertension, diabetes, trial group, and COVID-19 waves (pre-alpha or alpha and delta). FINDINGS Between June 29, 2020, and Sept 30, 2021, 882 participants recently infected with SARS-CoV-2 were enrolled, of whom 506 (57%) were female and 376 (43%) were male. 688 (78%) of 882 participants were unvaccinated, 55 (6%) were partly vaccinated, and 139 (16%) were fully vaccinated at baseline. After adjusting for confounders, geometric mean concentrations of interleukin (IL)-2RA, IL-7, IL-8, IL-15, IL-29 (interferon-λ), inducible protein-10, monocyte chemoattractant protein-1, and tumour necrosis factor-α were significantly lower among the fully vaccinated group than in the unvaccinated group at screening. On day 90, fully vaccinated participants had approximately 20% lower geometric mean concentrations of IL-7, IL-8, and vascular endothelial growth factor-A than unvaccinated participants. Cytokine and chemokine concentrations decreased over time in the fully and partly vaccinated groups and unvaccinated group. Log10 cytokine and chemokine concentrations decreased faster among participants in the unvaccinated group than in other groups, but their geometric mean concentrations were generally higher than fully vaccinated participants at 90 days. Days since full vaccination and type of vaccine received were not correlated with cytokine and chemokine concentrations. INTERPRETATION Initially and during recovery from symptomatic COVID-19, fully vaccinated participants had lower concentrations of inflammatory markers than unvaccinated participants suggesting vaccination is associated with short-term and long-term reduction in inflammation, which could in part explain the reduced disease severity and mortality in vaccinated individuals. FUNDING US Department of Defense, National Institutes of Health, Bloomberg Philanthropies, State of Maryland, Mental Wellness Foundation, Moriah Fund, Octapharma, HealthNetwork Foundation, and the Shear Family Foundation.
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Affiliation(s)
- Xianming Zhu
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kelly A Gebo
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Alison G Abraham
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Feben Habtehyimer
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Eshan U Patel
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Washington, DC, USA
| | - Thomas J Gniadek
- Department of Pathology and Laboratory Medicine, Northshore University Health System, Evanston, IL, USA
| | - Reinaldo E Fernandez
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Owen R Baker
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Malathi Ram
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Edward R Cachay
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA, USA
| | - Judith S Currier
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, CA, USA
| | - Yuriko Fukuta
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
| | - Jonathan M Gerber
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Sonya L Heath
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Barry Meisenberg
- Department of Medicine and Research Institute of Luminis Health, Annapolis, MD, USA
| | - Moises A Huaman
- Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH, USA
| | - Adam C Levine
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Aarthi Shenoy
- Division of Hematology, Medstar DC Hospital, Washington, DC, USA
| | - Shweta Anjan
- Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Janis E Blair
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Daniel Cruser
- Department of Pathology, Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY, USA
| | - Donald N Forthal
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, CA, USA
| | - Laura L Hammitt
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Seble Kassaye
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
| | - Giselle S Mosnaim
- Division of Allergy and Immunology, Department of Medicine, Northshore University Health System, Evanston, IL, USA
| | - Bela Patel
- Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - James H Paxton
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, NM, USA
| | | | | | - Patrick Broderick
- Department of Emergency Medicine, Nuvance Health Danbury Hospital, Danbury, CT, USA
| | - Valerie Cluzet
- Department of Infectious Disease, Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY, USA
| | - Marie Elena Cordisco
- Department of Emergency Medicine, Nuvance Health Danbury Hospital, Danbury, CT, USA
| | - Benjamin Greenblatt
- Department of Emergency Medicine, Nuvance Health Norwalk Hospital, Norwark, CT, USA
| | - Joann Petrini
- Department of Emergency Medicine, Nuvance Health Danbury Hospital, Danbury, CT, USA
| | - William Rausch
- Department of Emergency Medicine, Nuvance Health Danbury Hospital, Danbury, CT, USA
| | - David Shade
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Karen Lane
- Department of Neurology, Brain Injury Outcomes Division, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Amy L Gawad
- Department of Molecular Microbiology and Immunology, Johns Hopkins University, Baltimore, MD, USA
| | - Sabra L Klein
- Department of Molecular Microbiology and Immunology, Johns Hopkins University, Baltimore, MD, USA
| | - Andrew Pekosz
- Department of Molecular Microbiology and Immunology, Johns Hopkins University, Baltimore, MD, USA
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins University, Baltimore, MD, USA
| | - Evan M Bloch
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel Hanley
- Department of Neurology, Brain Injury Outcomes Division, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - David J Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins University, Baltimore, MD, USA
| | - Aaron A R Tobian
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
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19
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Huaman MA, Raval JS, Paxton JH, Mosnaim GS, Patel B, Anjan S, Meisenberg BR, Levine AC, Marshall CE, Yarava A, Shenoy AG, Heath SL, Currier JS, Fukuta Y, Blair JE, Spivak ES, Petrini JR, Broderick PB, Rausch W, Cordisco M, Hammel J, Greenblatt B, Cluzet VC, Cruser D, Oei K, Abinante M, Hammitt LL, Sutcliffe CG, Forthal DN, Zand MS, Cachay ER, Kassaye SG, Ram M, Wang Y, Das P, Lane K, McBee NA, Gawad AL, Karlen N, Ford DE, Laeyendecker O, Pekosz A, Klein SL, Ehrhardt S, Lau B, Baksh SN, Shade DM, Casadevall A, Hanley DF, Ou J, Gniadek TJ, Ziman A, Shoham S, Gebo KA, Bloch EM, Tobian AAR, Sullivan DJ, Gerber JM. Transfusion reactions associated with COVID-19 convalescent plasma in outpatient clinical trials. Transfusion 2023; 63:1639-1648. [PMID: 37534607 PMCID: PMC10720768 DOI: 10.1111/trf.17485] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND COVID-19 convalescent plasma (CCP) is an important therapeutic option for outpatients at high risk of hospitalization from SARS-CoV-2 infection. We assessed the safety of outpatient CCP transfusions administered during clinical trials. STUDY DESIGN AND METHODS We analyzed data pertaining to transfusion-related reactions from two randomized controlled trials in the U.S. that evaluated the efficacy of CCP versus control plasma in various ambulatory settings. Multivariable logistic regression was used to assess whether CCP was associated with transfusion reactions, after adjusting for potential confounders. RESULTS The combined study reported 79/1351 (5.9%) adverse events during the transfusion visit, with the majority 62/1351 (4.6%) characterized by mild, allergic-type findings of urticaria, and/or pruritus consistent with minor allergic transfusion reactions; the other reported events were attributed to the patients' underlying disease, COVID-19, or vasovagal in nature. We found no difference in the likelihood of allergic transfusion reactions between those receiving CCP versus control plasma (adjusted odds ratio [AOR], 0.75; 95% CI, 0.43-1.31). Risk of urticaria and/or pruritus increased with a pre-existing diagnosis of asthma (AOR, 2.33; 95% CI, 1.16-4.67). We did not observe any CCP-attributed antibody disease enhancement in participants with COVID-19 or increased risk of infection. There were no life-threatening severe transfusion reactions and no patients required hospitalization related to transfusion-associated complications. DISCUSSION Outpatient plasma administration was safely performed for nearly 1400 participants. CCP is a safe therapeutic option for outpatients at risk of hospitalization from COVID-19.
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Affiliation(s)
- Moises A Huaman
- Department of Internal Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - James H Paxton
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA
| | - Giselle S Mosnaim
- Department of Medicine, Division of Allergy and Immunology, NorthShore University Health System, Evanston, Illinois, USA
| | - Bela Patel
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - Shweta Anjan
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Adam C Levine
- Department of Emergency Medicine, Rhode Island Hospital & Brown University, Providence, Rhode Island, USA
| | - Christi E Marshall
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anusha Yarava
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aarthi G Shenoy
- Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center, DC, USA
| | - Sonya L Heath
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Judith S Currier
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, USA
| | - Yuriko Fukuta
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Janis E Blair
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Emily S Spivak
- Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | | | | | | | - Jean Hammel
- Nuvance Health Norwalk Hospital, Norwalk, Connecticut, USA
| | | | - Valerie C Cluzet
- Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, New York, USA
| | - Daniel Cruser
- Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, New York, USA
| | - Kevin Oei
- Ascada Research, Fullerton, California, USA
| | | | - Laura L Hammitt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Catherine G Sutcliffe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Donald N Forthal
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, California, USA
| | - Martin S Zand
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Edward R Cachay
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, California, USA
| | - Seble G Kassaye
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, DC, USA
| | - Malathi Ram
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ying Wang
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Piyali Das
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Karen Lane
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nichol A McBee
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amy L Gawad
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicky Karlen
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel E Ford
- Institute for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Oliver Laeyendecker
- The Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Andrew Pekosz
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sabra L Klein
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stephan Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sheriza N Baksh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - David M Shade
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Daniel F Hanley
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jiangda Ou
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thomas J Gniadek
- Department of Pathology and Laboratory Medicine, NorthShore University Health System, Evanston, Illinois, USA
| | - Alyssa Ziman
- Department of Pathology and Laboratory Medicine, Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly A Gebo
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David J Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jonathan M Gerber
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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20
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Hederman AP, Natarajan H, Heyndrickx L, Ariën KK, Wiener JA, Wright PF, Bloch EM, Tobian AAR, Redd AD, Blankson JN, Rottenstreich A, Zarbiv G, Wolf D, Goetghebuer T, Marchant A, Ackerman ME. SARS-CoV-2 vaccination elicits broad and potent antibody effector functions to variants of concern in vulnerable populations. Nat Commun 2023; 14:5171. [PMID: 37620337 PMCID: PMC10449910 DOI: 10.1038/s41467-023-40960-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 08/17/2023] [Indexed: 08/26/2023] Open
Abstract
SARS-CoV-2 variants have continuously emerged in the face of effective vaccines. Reduced neutralization against variants raises questions as to whether other antibody functions are similarly compromised, or if they might compensate for lost neutralization activity. Here, the breadth and potency of antibody recognition and effector function is surveyed following either infection or vaccination. Considering pregnant women as a model cohort with higher risk of severe illness and death, we observe similar binding and functional breadth for healthy and immunologically vulnerable populations, but considerably greater functional antibody breadth and potency across variants associated with vaccination. In contrast, greater antibody functional activity targeting the endemic coronavirus OC43 is noted among convalescent individuals, illustrating a dichotomy in recognition between close and distant human coronavirus strains associated with exposure history. This analysis of antibody functions suggests the differential potential for antibody effector functions to contribute to protecting vaccinated and convalescent subjects as novel variants continue to evolve.
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Affiliation(s)
| | - Harini Natarajan
- Department of Immunology and Microbiology, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA
| | - Leo Heyndrickx
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kevin K Ariën
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Joshua A Wiener
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Peter F Wright
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Andrew D Redd
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Joel N Blankson
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Gila Zarbiv
- Clinical Virology Unit, Hadassah University Medical Center, Jerusalem, Israel
| | - Dana Wolf
- Clinical Virology Unit, Hadassah University Medical Center, Jerusalem, Israel
| | - Tessa Goetghebuer
- Institute for Medical Immunology, Université libre de Bruxelles, Charleroi, Belgium
- Pediatric Department, CHU St Pierre, Brussels, Belgium
| | - Arnaud Marchant
- Institute for Medical Immunology, Université libre de Bruxelles, Charleroi, Belgium
| | - Margaret E Ackerman
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA.
- Department of Immunology and Microbiology, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA.
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21
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Bloch EM, Siller A, Tonnetti L, Drews SJ, Spencer BR, Hedges D, Mergenthal T, Weber-Schehl M, Astl M, Patel EU, Gaber M, Schennach H. Molecular Screening of Blood Donors for Babesia in Tyrol, Austria. Transfus Med Hemother 2023; 50:330-333. [PMID: 37767285 PMCID: PMC10521223 DOI: 10.1159/000528793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 12/19/2022] [Indexed: 09/29/2023] Open
Abstract
Introduction Babesia is a tick-borne intraerythrocytic parasite that is globally ubiquitous, yet understudied. Several species of Babesia have been shown to be transfusion-transmissible. Babesia has been reported in blood donors, animals, and ticks in the Tyrol (Western Austria), and regional cases of human babesiosis have been described. We sought to characterize the risk of Babesia to the local blood supply. Methods Prospective molecular testing was performed on blood donors who presented to regional, mobile blood collection drives in the Tyrol, Austria (27 May to October 4, 2021). Testing was conducted using the cobas® Babesia assay (Roche Molecular Systems, Inc.), a commercial PCR assay approved for blood donor screening that is capable of detecting the 4 primary species causing human babesiosis (i.e., B. microti, B. divergens, B. duncani, and B. venatorum). A confirmatory algorithm to manage initial PCR-reactive samples was developed, as were procedures for donor and product management. Results A total of 7,972 donors were enrolled and screened; 4,311 (54.1%) were male, with a median age of 47 years (IQR = 34-55). No positive cases of Babesia were detected, corresponding with an overall prevalence of 0.00% (95% CI: 0.00%, 0.05%). Discussion The findings suggest that the prevalence of Babesia is low in Austrian blood donors residing in the Tyrol, even during months of peak tick exposure. Although one cannot conclude the absence of Babesia in this population given the limited sample size, the findings suggest that the regional risk of transfusion-transmitted babesiosis is low.
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Affiliation(s)
- Evan M. Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anita Siller
- Central Institute for Blood Transfusion and Immunology, Innsbruck, Austria
| | - Laura Tonnetti
- Holland Laboratories for the Biomedical Sciences, American Red Cross, Rockville, Maryland, USA
| | - Steven J. Drews
- Microbiology, Canadian Blood Services, Edmonton, Alberta, Canada
| | - Bryan R. Spencer
- Scientific Affairs, American Red Cross, Dedham, Massachusetts, USA
| | - Doris Hedges
- Blood donor service, Bavarian Red Cross, Wiesentheid, Germany
| | | | | | - Manfred Astl
- Central Institute for Blood Transfusion and Immunology, Innsbruck, Austria
| | - Eshan U. Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Manfred Gaber
- Blood donor service Tyrol, Austrian Red Cross, Rum, Austria
| | - Harald Schennach
- Central Institute for Blood Transfusion and Immunology, Innsbruck, Austria
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22
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Alkhazashvili M, Bloch EM, Shadaker S, Kuchuloria T, Getia V, Turdziladze A, Armstrong PA, Gamkrelidze A. Advancing blood transfusion safety using molecular detection in the country of Georgia. Transfus Clin Biol 2023; 30:307-313. [PMID: 36907246 PMCID: PMC10958484 DOI: 10.1016/j.tracli.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND In 2015, the country of Georgia initiated its hepatitis C virus (HCV) elimination program. Given a high background incidence of HCV infection, centralized nucleic acid testing (NAT) of blood donations was prioritized for implementation. STUDY DESIGN AND METHODS Multiplex NAT screening for HIV, HCV and hepatitis B virus (HBV) was launched in January 2020. An analysis was conducted of serological and NAT donor/donation data for the first year of screening (through December 2020). RESULTS A total of 54,116 donations representing 39,164 unique donors were evaluated. Overall, 671 donors (1.7%) tested positive for at least one infectious marker by serology or NAT, with the highest prevalence among donors aged 40-49 years (2.5%; n = 200), male (1.9%; n = 524), replacement (2.8%; n = 153) and first time (2.1%; n = 642) donors. Sixty donations were seronegative but NAT positive, and therefore would not have been found by traditional serology testing alone. These were more likely among female vs. male (adjusted odds ratio [aOR] 2.06; 95% confidence interval [95%CI]: 1.05-4.05), paid (aOR 10.15; 95%CI: 2.80-36.86) or voluntary (aOR 4.30; 95%CI: 1.27-14.56) vs replacement, and repeat vs. first time (aOR 13.98; 95%CI: 4.06-48.12) donors. On repeat serological testing (including HBV core antibody [HBcAb] testing), 6 HBV + donations, 5 HCV + donations and 1 HIV + donations were deemed NAT yield (detected through the implementation of NAT, and would have otherwise been missed by serology screening alone). CONCLUSION This analysis offers a regional model for NAT implementation, demonstrating the feasibility and clinical utility in a nationwide blood program.
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Affiliation(s)
- Maia Alkhazashvili
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia; The University of Georgia, School of Health Sciences, Tbilisi, Georgia.
| | - Evan M Bloch
- Johns Hopkins University School of Medicine, Baltimore, United States
| | - Shaun Shadaker
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD and TB Prevention, CDC, Atlanta, United States
| | | | - Vladimer Getia
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | | | - Paige A Armstrong
- Johns Hopkins University School of Medicine, Baltimore, United States
| | - Amiran Gamkrelidze
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia; The University of Georgia, School of Health Sciences, Tbilisi, Georgia
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23
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Bloch EM, Goel R, Zhu X, Patel EU, Shoham S, Sullivan DJ, Gebo KA, Casadevall A, Tobian AAR. Coronavirus Disease 2019 Convalescent Plasma Utilization in the United States: Data From the National Inpatient Sample. Clin Infect Dis 2023; 77:237-241. [PMID: 36987595 PMCID: PMC10371309 DOI: 10.1093/cid/ciad185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/14/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) convalescent plasma (CCP) use between October and December 2020 was characterized using the National Inpatient Sample database. CCP was administered in 18.0% of COVID-19-associated hospitalizations and was strongly associated with older age and increased disease severity. There were disparities in the receipt of CCP by race and ethnicity, geography, and insurance.
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Affiliation(s)
- Evan M Bloch
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ruchika Goel
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
- Simmons Cancer Institute at Southern Illinois University, Springfield, Illinois, USA
| | - Xianming Zhu
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Eshan U Patel
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David J Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kelly A Gebo
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
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Mercure-Corriveau N, Roy S, Hu C, Crowe EP, Zhu X, Obando D, Patel EU, Tobian AAR, Wang Y, Bloch EM, Newsome SD. Therapeutic plasma exchange in the management of stiff person syndrome spectrum disorders: a case series and review of the literature. Ther Adv Neurol Disord 2023; 16:17562864231180736. [PMID: 37529719 PMCID: PMC10387686 DOI: 10.1177/17562864231180736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 05/11/2023] [Indexed: 08/03/2023] Open
Abstract
Background Stiff person syndrome spectrum disorders (SPSD) are a rare group of disabling neuroimmunological disorders. SPSD often requires immune therapies, especially in the setting of inadequate response to symptomatic treatments. The safety and efficacy of therapeutic plasma exchange (TPE) in SPSD remains uncertain. Objectives To describe the safety, tolerability, and efficacy of TPE in patients with SPSD. Design A retrospective observational study. Methods A retrospective review of SPSD patients seen at Johns Hopkins Hospital (JHH) from 1997 to 2021 was performed. Patient demographics/history, examination/diagnostic findings, treatment response, and TPE-related complications were recorded. Assessment for any associations between clinical characteristics, including age, sex, clinical phenotype, and time on immunotherapy, and response to TPE 3 months after treatment was performed. A subgroup of 18 patients treated with TPE at JHH and 6 patients treated with TPE at outside institutions were evaluated for any change in usage of symptomatic medications 3 months after the TPE treatment. Literature review of SPSD and TPE was also conducted. Results Thirty-nine SPSD patients were treated with TPE (21 at JHH and 18 at outside institutions); median age 48 years, 77% female, median modified Rankin Scale 3; mean initial anti-GAD65 antibody titer was 23,508 U/mL. Twenty-four patients (62%) had classic SPS, 10 (26%) had SPS-plus, 2 (5%) had progressive encephalomyelitis with rigidity and myoclonus, and 3 (8%) had pure cerebellar ataxia. All patients were on symptomatic treatments, 30 (77%) previously received IVIg, and 3 (8%) previously received rituximab. Four patients (10%) had a TPE-related adverse event. One developed asymptomatic hypotension, another had both line thrombosis and infection, and two had non-life-threatening bleeding events. Twenty-three (59%) patients reported improvement in symptoms after TPE. Of the subgroup of 24 patients evaluated for any change in usage of symptomatic medications 3 months after the TPE treatment, 14 (58%) required fewer GABAergic symptomatic medications. Literature review identified 57 additional patients with SPSD; 43 (75%) reported temporary improvement after TPE. Conclusion The majority of patients treated with TPE had improvement. Moreover, most patients evaluated for any change in usage of symptomatic medications after the TPE treatment no longer required as much symptomatic medications months after TPE. TPE appears safe and well-tolerated in SPSD. Further studies are needed to assess the long-term efficacy of TPE in SPSD and identify which patients may benefit the most from TPE.
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Affiliation(s)
- Nicolas Mercure-Corriveau
- Division of Transfusion Medicine, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Shuvro Roy
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Chen Hu
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Elizabeth P. Crowe
- Division of Transfusion Medicine, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Xianming Zhu
- Division of Transfusion Medicine, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Danielle Obando
- Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Eshan U. Patel
- Division of Transfusion Medicine, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Aaron A. R. Tobian
- Division of Transfusion Medicine, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Yujie Wang
- Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Evan M. Bloch
- Division of Transfusion Medicine, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Scott D. Newsome
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University, School of Medicine, 600 North Wolfe Street, Pathology 627, Baltimore, MD 21287, USA
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McConnell SA, Sachithanandham J, Mudrak NJ, Zhu X, Farhang PA, Cordero RJB, Wear MP, Shapiro JR, Park HS, Klein SL, Tobian AAR, Bloch EM, Sullivan DJ, Pekosz A, Casadevall A. Spike-protein proteolytic antibodies in COVID-19 convalescent plasma contribute to SARS-CoV-2 neutralization. Cell Chem Biol 2023; 30:726-738.e4. [PMID: 37354908 PMCID: PMC10288624 DOI: 10.1016/j.chembiol.2023.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/23/2023] [Accepted: 05/26/2023] [Indexed: 06/26/2023]
Abstract
Understanding the mechanisms of antibody-mediated neutralization of SARS-CoV-2 is critical in combating the COVID-19 pandemic. Based on previous reports of antibody catalysis, we investigated the proteolysis of spike (S) by antibodies in COVID-19 convalescent plasma (CCP) and its contribution to viral neutralization. Quenched fluorescent peptides were designed based on S epitopes to sensitively detect antibody-mediated proteolysis. We observed epitope cleavage by CCP from different donors which persisted when plasma was heat-treated or when IgG was isolated from plasma. Further, purified CCP antibodies proteolyzed recombinant S domains, as well as authentic viral S. Cleavage of S variants suggests CCP antibody-mediated proteolysis is a durable phenomenon despite antigenic drift. We differentiated viral neutralization occurring via direct interference with receptor binding from that occurring by antibody-mediated proteolysis, demonstrating that antibody catalysis enhanced neutralization. These results suggest that antibody-catalyzed damage of S is an immunologically relevant function of neutralizing antibodies against SARS-CoV-2.
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Affiliation(s)
- Scott A McConnell
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Jaiprasath Sachithanandham
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Nathan J Mudrak
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Xianming Zhu
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Parsa Alba Farhang
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Radames J B Cordero
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Maggie P Wear
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Janna R Shapiro
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD 21205, USA
| | - Han-Sol Park
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD 21205, USA; Department of Biochemistry and Molecular Biology, Johns Hopkins School of Public Health, Baltimore, MD 21205, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - David J Sullivan
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Arturo Casadevall
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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26
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Bloch EM, Kyeyune D, White JL, Ddungu H, Ashokkumar S, Habtehyimer F, Baker O, Kasirye R, Patel EU, Grabowski MK, Musisi E, Moses K, Hume HA, Lubega I, Shrestha R, Motevalli M, Fernandez RE, Reynolds SJ, Redd AD, Wambongo Musana H, Dhabangi A, Ouma J, Eroju P, de Lange T, Fowler MG, Musoke P, Stramer SL, Whitby D, Zimmerman PA, McCullough J, Sachithanandham J, Pekosz A, Goodrich R, Quinn TC, Ness PM, Laeyendecker O, Tobian AAR. SARS-CoV-2 seroprevalence among blood donors in Uganda: 2019-2022. Transfusion 2023; 63:1354-1365. [PMID: 37255467 PMCID: PMC10525030 DOI: 10.1111/trf.17449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND The true burden of COVID-19 in low- and middle-income countries remains poorly characterized, especially in Africa. Even prior to the availability of SARS-CoV-2 vaccines, countries in Africa had lower numbers of reported COVID-19 related hospitalizations and deaths than other regions globally. METHODS Ugandan blood donors were evaluated between October 2019 and April 2022 for IgG antibodies to SARS-CoV-2 nucleocapsid (N), spike (S), and five variants of the S protein using multiplexed electrochemiluminescence immunoassays (MesoScale Diagnostics, Rockville, MD). Seropositivity for N and S was assigned using manufacturer-provided cutoffs and trends in seroprevalence were estimated by quarter. Statistically significant associations between N and S antibody seropositivity and donor characteristics in November-December 2021 were assessed by chi-square tests. RESULTS A total of 5393 blood unit samples from donors were evaluated. N and S seropositivity increased throughout the pandemic to 82.6% in January-April 2022. Among seropositive individuals, N and S antibody levels increased ≥9-fold over the study period. In November-December 2021, seropositivity to N and S antibody was higher among repeat donors (61.3%) compared with new donors (55.1%; p = .043) and among donors from Kampala (capital city of Uganda) compared with rural regions (p = .007). Seropositivity to S antibody was significantly lower among HIV-seropositive individuals (58.8% vs. 84.9%; p = .009). CONCLUSIONS Despite previously reported low numbers of COVID-19 cases and related deaths in Uganda, high SARS-CoV-2 seroprevalence and increasing antibody levels among blood donors indicated that the country experienced high levels of infection over the course of the pandemic.
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Affiliation(s)
- Evan M Bloch
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Jodie L White
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Swetha Ashokkumar
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Feben Habtehyimer
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Owen Baker
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Eshan U Patel
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - M Kate Grabowski
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ezra Musisi
- Uganda Blood Transfusion Services, Kampala, Uganda
| | - Khan Moses
- Uganda Blood Transfusion Services, Kampala, Uganda
| | - Heather A Hume
- Department of Pediatrics, University of Montreal, Montréal, Quebec, Canada
| | | | - Ruchee Shrestha
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mahnaz Motevalli
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Reinaldo E Fernandez
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Steven J Reynolds
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrew D Redd
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Aggrey Dhabangi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joseph Ouma
- MUJHU Research Collaboration, Kampala, Uganda
| | | | - Telsa de Lange
- National Institute of Allergy and Infectious Diseases Office of Cyber Infrastructure and Computational Biology, Bethesda, Maryland, USA
| | - Mary Glenn Fowler
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Susan L Stramer
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland, USA
| | - Denise Whitby
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Peter A Zimmerman
- The Center for Global Health & Diseases, Pathology Department, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jeffrey McCullough
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Jaiprasath Sachithanandham
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew Pekosz
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Raymond Goodrich
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Thomas C Quinn
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Paul M Ness
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Aaron A R Tobian
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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27
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Bloch EM, Focosi D, Shoham S, Senefeld J, Tobian AAR, Baden LR, Tiberghien P, Sullivan DJ, Cohn C, Dioverti V, Henderson JP, So-Osman C, Juskewitch JE, Razonable RR, Franchini M, Goel R, Grossman BJ, Casadevall A, Joyner MJ, Avery RK, Pirofski LA, Gebo KA. Guidance on the Use of Convalescent Plasma to Treat Immunocompromised Patients With Coronavirus Disease 2019. Clin Infect Dis 2023; 76:2018-2024. [PMID: 36740590 PMCID: PMC10249987 DOI: 10.1093/cid/ciad066] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/23/2023] [Accepted: 02/03/2023] [Indexed: 02/07/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) convalescent plasma (CCP) is a safe and effective treatment for COVID-19 in immunocompromised (IC) patients. IC patients have a higher risk of persistent infection, severe disease, and death from COVID-19. Despite the continued clinical use of CCP to treat IC patients, the optimal dose, frequency/schedule, and duration of CCP treatment has yet to be determined, and related best practices guidelines are lacking. A group of individuals with expertise spanning infectious diseases, virology and transfusion medicine was assembled to render an expert opinion statement pertaining to the use of CCP for IC patients. For optimal effect, CCP should be recently and locally collected to match circulating variant. CCP should be considered for the treatment of IC patients with acute and protracted COVID-19; dosage depends on clinical setting (acute vs protracted COVID-19). CCP containing high-titer severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies, retains activity against circulating SARS-CoV-2 variants, which have otherwise rendered monoclonal antibodies ineffective.
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Affiliation(s)
- Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, Pisa, Italy
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jonathon Senefeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lindsey R Baden
- Department of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Pierre Tiberghien
- Etablissement Français du Sang, La Plaine-St-Denis and Université de Franche-Comté, Besançon, France
| | - David J Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claudia Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Veronica Dioverti
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeffrey P Henderson
- Departments of Internal Medicine (Division of Infectious Diseases) and Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Cynthia So-Osman
- Department Transfusion Medicine, Division Blood Bank, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
- Department Haematology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Justin E Juskewitch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester campus, Minnesota, USA
| | - Raymund R Razonable
- Department of Internal Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Massimo Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantua, Italy
| | - Ruchika Goel
- Division of Hematology/Oncology, Simmons Cancer Institute at SIU School of Medicine and Mississippi Valley Regional Blood Center, Springfield, Illinois, USA
| | - Brenda J Grossman
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Robin K Avery
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Liise-anne Pirofski
- Department of Medicine, Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kelly A Gebo
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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28
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Goel R, Zhu X, Makhani S, Josephson CD, White JL, Karam O, Nellis ME, Gehrie EA, Sherpa M, Crowe EP, Bloch EM, Tobian AA. Pediatric firearm injury related emergency department visits and hospitalizations: a population-based study in the United States. Lancet Reg Health Am 2023; 22:100503. [PMID: 37214769 PMCID: PMC10192937 DOI: 10.1016/j.lana.2023.100503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023]
Abstract
Background Firearm injury (FI) is the leading cause of death in children and adolescents in the United States (US). We describe the epidemiology of pediatric FI-associated emergency department (ED) visits and hospitalizations in the US stratified by race and ethnicity. Methods Data on pediatric (0-17-year-olds) FI were analyzed using the 2019 Nationwide Emergency Department Sample (NEDS) and Kids' Inpatient Database (KID), the largest all-payer databases in the US for ED visits and pediatric hospitalizations, respectively. FI encounters were stratified by race and ethnicity. Poisson regression was used to identify factors associated with in-hospital mortality. Sampling weights were applied to generate nationally representative estimates. Findings There were 7017 pediatric ED visits with FI (NEDS); 85.0% (5961/7017) were male and 73.0% (5125/7017) were adolescents (15-17 years). Overall, 5.5% (384/7017) died in the ED; 53.1% (3727/7017) of ED encounters did not result in hospitalization. There were 2817 pediatric FI hospitalizations (KID); 84.1% (2369/2817) were male and 71.6% (2018/2817) were adolescents; 51.4% (1447/2817) of FI were unintentional, 42.8% (1207/2817) were assault-related, and 5.8% (163/2817) were self-inflicted. Black children had the highest proportion (52.6%; 1481/2817) of hospitalizations among all race and ethnicities (p < 0.0001 vs. White). White children had the highest proportion of hospitalizations for self-inflicted injuries (16.6% [91/551] vs. 4.9% [25/504; p < 0.0001] in Hispanics and 1.7% [24/1481] in Blacks; p < 0.0001). The majority (56.5%; 1591/2817) of hospitalizations were patients from low-income zip codes (median annual-household-income <$44,000); 70% (1971/2817) had Medicaid as the primary insurance payer. Overall, 8.0% (225/2817) died during FI-associated hospitalizations. Self-inflicted injuries had the highest in-hospital mortality (prevalence ratio = 8.20, 95% CI = 6.06-11.10 vs. unintentional). Interpretation Black children and children with lower household incomes were disproportionately impacted by FI resulting from assaults and accidents, while White children had the highest proportion of self-inflicted FI injuries. Public health and legal policy interventions are needed to prevent pediatric FI. Funding US National Institutes of Health.
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Affiliation(s)
- Ruchika Goel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Simmons Cancer Institute at SIU School of Medicine, Springfield, IL, USA
| | - Xianming Zhu
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah Makhani
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Cassandra D. Josephson
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Jodie L. White
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Oliver Karam
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Eric A. Gehrie
- American Red Cross, Biomedical Services Division, National Headquarters, Washington, DC, USA
| | | | - Elizabeth P. Crowe
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Evan M. Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aaron A.R. Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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29
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Baksh SN, Heath SL, Fukuta Y, Shade D, Meisenberg B, Bloch EM, Tobian AAR, Spivak ES, Patel B, Gerber J, Raval JS, Forthal D, Paxton J, Mosnaim G, Anjan S, Blair J, Cachay E, Currier J, Das P, Huaman M, Sutcliffe C, Yarava A, Casadevall A, Sullivan D, Hanley D, Gebo KA. Symptom Duration and Resolution With Early Outpatient Treatment of Convalescent Plasma for Coronavirus Disease 2019: A Randomized Trial. J Infect Dis 2023; 227:1266-1273. [PMID: 36722044 PMCID: PMC10226658 DOI: 10.1093/infdis/jiad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/20/2023] [Accepted: 01/26/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) convalescent plasma (CCP) reduces hospitalizations among outpatients treated early after symptom onset. It is unknown whether CCP reduces time to symptom resolution among outpatients. METHODS We evaluated symptom resolution at day 14 by trial arm using an adjusted subdistribution hazard model, with hospitalization as a competing risk. We also assessed the prevalence of symptom clusters at day 14 between treatments. Clusters were defined based on biologic clustering, impact on ability to work, and an algorithm. RESULTS Among 1070 outpatients followed up after transfusion, 381 of 538 (70.8%) receiving CCP and 381 of 532 (71.6%) receiving control plasma were still symptomatic (P = .78) at day 14. Associations between CCP and symptom resolution by day 14 did not differ significantly from those in controls after adjustment for baseline characteristics (adjusted subdistribution hazard ratio, 0.99; P = .62). The most common cluster consisted of cough, fatigue, shortness of breath, and headache and was found in 308 (57.2%) and 325 (61.1%) of CCP and control plasma recipients, respectively (P = .16). CONCLUSIONS In this trial of outpatients with early COVID-19, CCP was not associated with faster resolution of symptoms compared with control. Overall, there were no differences by treatment in the prevalence of each symptom or symptom clusters at day 14. CLINICAL TRIALS REGISTRATION NCT04373460.
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Affiliation(s)
- Sheriza N Baksh
- Department of Epidemiology Bloomberg Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Sonya L Heath
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yuriko Fukuta
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - David Shade
- Department of Epidemiology Bloomberg Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Barry Meisenberg
- Department of Medicine and Research Institute of Luminis Health, Annapolis, Maryland, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Emily S Spivak
- Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, Utah, USA
| | - Bela Patel
- Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - Jonathan Gerber
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, Massachusetts, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Donald Forthal
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, California, USA
| | - James Paxton
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA
| | - Giselle Mosnaim
- Department of Medicine Northshore University Health System, Division of Allergy and Immunology, Evanston, Illinois, USA
| | - Shweta Anjan
- Department of Medicine, Division of Infectious Diseases, University of Miami, Miami, Florida, USA
| | - Janis Blair
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Phoenix, Phoenix, Arizona, USA
| | - Edward Cachay
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, La Jolla, California, USA
| | - Judith Currier
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, California, USA
| | - Piyali Das
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Moises Huaman
- Department of Medicine, Division of Infectious Diseases, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Catherine Sutcliffe
- Department of Epidemiology Bloomberg Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Anusha Yarava
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Arturo Casadevall
- Departments of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David Sullivan
- Departments of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel Hanley
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly A Gebo
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Van Denakker TA, Al-Riyami AZ, Feghali R, Gammon R, So-Osman C, Crowe EP, Goel R, Rai H, Tobian AAR, Bloch EM. Managing blood supplies during natural disasters, humanitarian emergencies and pandemics: lessons learned from COVID-19. Expert Rev Hematol 2023:1-14. [PMID: 37129864 DOI: 10.1080/17474086.2023.2209716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has resulted in a historic public health crisis with widespread social and economic ramifications. The pandemic has also affected the blood supply resulting in unprecedented and sustained blood shortages. AREAS COVERED This review describes the challenges of maintaining a safe and sufficient blood supply in the wake of natural disasters, humanitarian emergencies and pandemics. The challenges, which are accentuated in low- and high- income countries, span the impact on human capacity (affecting blood donors and blood collections personnel alike), disruption to supply chains, and economic sustainability. COVID-19 imparted lessons on how to offset these challenges, which may be applied to future pandemics and public health crises. EXPERT OPINION Pandemic emergency preparedness plans should be implemented or revised by blood centers and hospitals to lessen the impact to the blood supply. Comprehensive planning should address the timely assessment of risk to the blood supply, rapid donor recruitment and communication of need, measures to preserve safety for donors and operational staff, careful blood management, and resource sharing.
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Affiliation(s)
- Tayler A Van Denakker
- Johns Hopkins University School of Medicine, Department of Pathology, Transfusion Medicine Division, Baltimore, MD, USA
| | - Arwa Z Al-Riyami
- Department of Hematology, Sultan Qaboos University Hospital Sultan Qaboos University, Muscat, Oman
| | | | - Richard Gammon
- OneBlood, Scientific, Medical, Technical Direction, Orlando, Florida, USA
| | - Cynthia So-Osman
- Sanquin Blood Supply Foundation, Department of Transfusion medicine, Amsterdam, The Netherlands
| | - Elizabeth P Crowe
- Johns Hopkins University School of Medicine, Department of Pathology, Transfusion Medicine Division, Baltimore, MD, USA
| | - Ruchika Goel
- Johns Hopkins University School of Medicine, Department of Pathology, Transfusion Medicine Division, Baltimore, MD, USA
- Simmons Cancer Institute, Department of Internal Medicine, Springfield, IL, USA
| | - Herleen Rai
- Johns Hopkins University School of Medicine, Department of Pathology, Transfusion Medicine Division, Baltimore, MD, USA
| | - Aaron A R Tobian
- Johns Hopkins University School of Medicine, Department of Pathology, Transfusion Medicine Division, Baltimore, MD, USA
| | - Evan M Bloch
- Johns Hopkins University School of Medicine, Department of Pathology, Transfusion Medicine Division, Baltimore, MD, USA
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Burde J, Bloch EM, Kelly JR, Krause PJ. Human Borrelia miyamotoi Infection in North America. Pathogens 2023; 12:553. [PMID: 37111439 PMCID: PMC10145171 DOI: 10.3390/pathogens12040553] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023] Open
Abstract
Borrelia miyamotoi is an emerging pathogen that causes a febrile illness and is transmitted by the same hard-bodied (ixodid) ticks that transmit several other pathogens, including Borrelia species that cause Lyme disease. B. miyamotoi was discovered in 1994 in Ixodes persulcatus ticks in Japan. It was first reported in humans in 2011 in Russia. It has subsequently been reported in North America, Europe, and Asia. B. miyamotoi infection is widespread in Ixodes ticks in the northeastern, northern Midwestern, and far western United States and in Canada. In endemic areas, human B. miyamotoi seroprevalence averages from 1 to 3% of the population, compared with 15 to 20% for B. burgdorferi. The most common clinical manifestations of B. miyamotoi infection are fever, fatigue, headache, chills, myalgia, arthralgia, and nausea. Complications include relapsing fever and rarely, meningoencephalitis. Because clinical manifestations are nonspecific, diagnosis requires laboratory confirmation by PCR or blood smear examination. Antibiotics are effective in clearing infection and are the same as those used for Lyme disease, including doxycycline, tetracycline, erythromycin, penicillin, and ceftriaxone. Preventive measures include avoiding areas where B. miyamotoi-infected ticks are found, landscape management, and personal protective strategies such as protective clothing, use of acaricides, and tick checks with rapid removal of embedded ticks.
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Affiliation(s)
- Jed Burde
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06520, USA
| | - Evan M. Bloch
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, MD 21217, USA
| | - Jill R. Kelly
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT 06520, USA
| | - Peter J. Krause
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06520, USA
- Department of Medicine, Yale School of Medicine, New Haven, CT 06510, USA
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Custer B, Bloch EM, Bryant BJ, D'Alessandro A, Delaney M, Goel R, Hod EA, Josephson CD, Katz LM, Miller YM, Sayers MH, Seheult JN, Triulzi DJ, Berger J, Zou S, Hailu B, Glynn SA, Roubinian NH. Proceedings of the 2022 NHLBI and OASH state of the science in transfusion medicine symposium. Transfusion 2023; 63:1074-1091. [PMID: 37005871 DOI: 10.1111/trf.17296] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 02/18/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND State of the Science (SoS) meetings are used to define and highlight important unanswered scientific questions. The National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, and the Office of the Assistant Secretary for Health (OASH), Department of Health and Human Services held a virtual SoS in transfusion medicine (TM) symposium. STUDY DESIGN AND METHODS In advance of the symposium, six multidisciplinary working groups (WG) convened to define research priorities in the areas of: blood donors and the supply, optimizing transfusion outcomes for recipients, emerging infections, mechanistic aspects of components and transfusion, new computational methods in transfusion science, and impact of health disparities on donors and recipients. The overall objective was to identify key basic, translational, and clinical research questions that will help to increase and diversify the volunteer donor pool, ensure safe and effective transfusion strategies for recipients, and identify which blood products from which donors best meet the clinical needs of specific recipient populations. RESULTS On August 29-30, 2022, over 400 researchers, clinicians, industry experts, government officials, community members, and patient advocates discussed the research priorities presented by each WG. Dialogue focused on the five highest priority research areas identified by each WG and included the rationale, proposed methodological approaches, feasibility, and barriers for success. DISCUSSION This report summarizes the key ideas and research priorities identified during the NHLBI/OASH SoS in TM symposium. The report highlights major gaps in our current knowledge and provides a road map for TM research.
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Affiliation(s)
- Brian Custer
- Vitalant Research Institute, San Francisco, California, USA
- University of California, San Francisco, San Francisco, California, USA
| | - Evan M Bloch
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Barbara J Bryant
- Versiti, Milwaukee, Wisconsin, USA
- Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Meghan Delaney
- Children's National Hospital, Washington, District of Columbia, USA
| | - Ruchika Goel
- School of Medicine, Southern Illinois University, Carbondale, Illinois, USA
| | - Eldad A Hod
- Columbia University Irving Medical Center, New York City, New York, USA
| | - Cassandra D Josephson
- Johns Hopkins University, Baltimore, Maryland, USA
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | | | | | - Merlyn H Sayers
- Carter Blood Care, Bedford, Texas, USA
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Darrell J Triulzi
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - James Berger
- Department of Health and Human Services, Office of the Assistant Secretary of Health, Washington, District of Columbia, USA
| | - Shimian Zou
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Benyam Hailu
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Simone A Glynn
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Nareg H Roubinian
- Vitalant Research Institute, San Francisco, California, USA
- University of California, San Francisco, San Francisco, California, USA
- Kaiser Permanente Division of Research, Oakland, California, USA
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Abstract
From producing individual blood components for transfusion to the removal of pathogenic substances, apheresis is a cornerstone of modern medical therapies. The use of therapeutic plasma exchange (TPE), in which plasma and its soluble constituents are removed from the body in exchange for a replacement fluid, can be organ- and life-saving in many diseases. Given the notable similarities between TPE and hemodialysis, the nephrologist is often responsible for managing TPE. As such, one must be familiar with the technologies, approach to therapy, indications for use, and complications. TPE uses centrifugation or membrane separation technologies, with the latter able to be performed with certain hemodialysis machines familiar to the nephrologist. Furthermore, primary kidney diseases such as anti-glomerular basement membrane disease are frequently associated with autoantibodies, potentially making them ideal candidates for TPE. Nevertheless, the use of TPE in many kidney diseases is controversial because of the lack of supporting evidence. This review discusses TPE from the perspective of a nephrologist responsible for prescribing and managing TPE, as well as nephrologists engaged in the care of patients undergoing the procedure.
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Affiliation(s)
- C Elena Cervantes
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Evan M Bloch
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - C John Sperati
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
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Ipe TS, Eichbaum Q, El-Ekiaby M, Owusu-Ofori S, Vermeulen M, Mapako T, Tagny CT, Dembele B, Bloch EM, Barnes LS. Transfusion medicine research in Africa: Insights from investigators in the field. Vox Sang 2023; 118:281-287. [PMID: 36734301 PMCID: PMC11005390 DOI: 10.1111/vox.13407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Research in low-resource settings is inherently challenging. We sought to assess the factors that have impeded or facilitated transfusion medicine (TM) research in various African settings. MATERIALS AND METHODS A qualitative case study was conducted of selected investigators in Africa; selection was based on productivity-spanning publication, leadership and research in TM. We designed a questionnaire to explore the factors impeding or facilitating TM research to understand the impact on the investigators' careers. Written responses were independently coded and double-checked for precision. Qualitative analysis was conducted, whereby responses were grouped thematically and clustered by relationship. The initial findings were discussed with respondents to validate and refine the interpretations. The recorded transcript was analysed and incorporated into the final analysis. RESULTS Six investigators participated in the study. Their responses yielded 471 coded comments: 389 from the questionnaires and 82 from the ensuing discussion. The most frequently cited factors described included knowledge and intellectual abilities (n = 104), personal effectiveness (n = 99), research and governance structure (n = 97), and engagement, influence and impact (n = 75). Four relationship clusters emerged from the facilitators (n = 42), barriers (n = 28), and common approaches (n = 26) to research, informing summary themes of adaptation, collaboration, perseverance, and resiliency. CONCLUSION Individual attributes were found to be central to a successful TM research career in African settings. However, given other public health priorities and constraints, interpersonal relationships, organizational structures and the broader research context were important to TM researchers. Overcoming complexities demands adaptation, collaboration, perseverance and resiliency.
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Affiliation(s)
- Tina S. Ipe
- Medical Division, Our Blood Institute, Oklahoma City, Oklahoma, USA
- Department of Pathology and Laboratory Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Quentin Eichbaum
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Magdy El-Ekiaby
- Blood Transfusion and Hemophilia Center, Shabrawishi Hospital, Cairo, Egypt
| | | | - Marion Vermeulen
- The South African National Blood Service, Roodepoort, South Africa
| | - Tonderai Mapako
- Business Development Department, National Blood Service Zimbabwe, Harare, Zimbabwe
| | - Claude Tayou Tagny
- Department of Hematology and Blood Transfusion, University of Yaounde, Yaounde, Cameroon
| | - Bamory Dembele
- National Blood Transfusion Center Laboratory and, Pharmaceutical and Biological Sciences Training and Research Unit, University Félix Houphouet-Boigny, Abidjan, Côte d’Ivoire
| | - Evan M. Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Linda S. Barnes
- School of Public Health, University of Illinois, Chicago, Illinois, USA
- Linda S. Barnes Consulting, Seattle, Washington, USA
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Drews SJ, Wendel S, Leiby DA, Tonnetti L, Ushiro-Lumb I, O'Brien SF, Lieshout-Krikke RW, Bloch EM. Climate change and parasitic risk to the blood supply. Transfusion 2023; 63:638-645. [PMID: 36565251 DOI: 10.1111/trf.17234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/02/2022] [Accepted: 12/04/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Steven J Drews
- Canadian Blood Services, Microbiology, Donation Policy and Studies, Edmonton, Alberta, Canada
- Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Silvano Wendel
- Blood Bank, Hospital Sírio-Libanês Blood Bank, São Paulo, Brazil
| | - David A Leiby
- Department of Microbiology, Immunology, & Tropical Medicine, George Washington University, Washington, DC, USA
| | - Laura Tonnetti
- American Red Cross, Scientific Affairs, Holland Laboratories for the Biomedical Sciences, Rockville, Maryland, USA
| | | | - Sheila F O'Brien
- Canadian Blood Services, Epidemiology and Surveillance, Microbiology, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Ryanne W Lieshout-Krikke
- Department of Medical Affairs, Corporate Staff, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Costa V, Mercure-Corriveau N, Gourneau J, Tobian AAR, Jones JM, Lauriello A, Lanzkron S, Crowe EP, Bloch EM. Transfusion-transmitted babesiosis in a patient with sickle cell disease undergoing chronic red cell exchange. Transfusion 2023; 63:652-655. [PMID: 36637364 PMCID: PMC10033390 DOI: 10.1111/trf.17244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Prior to laboratory-based blood donor screening for Babesia, transfusion-transmitted babesiosis (TTB) was a leading infectious risk to the blood supply in the United States. CASE REPORT A 30-year-old man with sickle cell disease (SCD) who had been on a chronic automated red cell exchange (RCE) regimen since childhood, presented approximately 2 months after an RCE, with fever, neck pain, and photophobia. Meningitis was excluded, and he was discharged. He presented again 2 days later with persistent fever, chills, headache, fatigue, and loss of appetite. RESULTS On examination, the patient was febrile but hemodynamically stable. Intra-erythrocytic inclusions were identified on a peripheral blood smear (<0.5%). B. microti IgM and IgG titers were >1:320 (Reference <1:20) >1:1024 (Reference <1:64), respectively. B. microti was confirmed by nucleic acid testing. The patient lived in a Babesia endemic state but had no risk factors for tick-borne acquisition. Of the 65 units he received in the preceding 6 months, 58 had been screened for Babesia. One of the donors of the 7 untested units was B. microti seropositive (titer 1:128; Reference 1: 64). The donor was asymptomatic and resided in a state in which Babesia screening was not required. He reported traveling in the year before his donation. CONCLUSION Although rare, TTB is still possible despite regional screening, underscoring the need for provider vigilance and education, especially in non-endemic areas. Patients with SCD are particularly vulnerable given their high frequency of transfusion and complex needs requiring blood procurement from states where Babesia screening is not mandatory.
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Affiliation(s)
- Victoria Costa
- Department of Pathology and Laboratory Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | | | - Aaron A. R. Tobian
- Department of Pathology and Laboratory Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Jennifer M. Jones
- Department of Hematology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ashley Lauriello
- Department of Hematology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Sophie Lanzkron
- Department of Hematology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Elizabeth P. Crowe
- Department of Pathology and Laboratory Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Evan M. Bloch
- Department of Pathology and Laboratory Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Gebo KA, Heath SL, Fukuta Y, Zhu X, Baksh S, Abraham AG, Habtehyimer F, Shade D, Ruff J, Ram M, Laeyendecker O, Fernandez RE, Patel EU, Baker OR, Shoham S, Cachay ER, Currier JS, Gerber JM, Meisenberg B, Forthal DN, Hammitt LL, Huaman MA, Levine A, Mosnaim GS, Patel B, Paxton JH, Raval JS, Sutcliffe CG, Anjan S, Gniadek T, Kassaye S, Blair JE, Lane K, McBee NA, Gawad AL, Das P, Klein SL, Pekosz A, Casadevall A, Bloch EM, Hanley D, Tobian AAR, Sullivan DJ. Early Treatment, Inflammation and Post-COVID Conditions. medRxiv 2023:2023.02.13.23285855. [PMID: 36824860 PMCID: PMC9949202 DOI: 10.1101/2023.02.13.23285855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Background Post-COVID conditions (PCC) are common and have significant morbidity. Risk factors for PCC include advancing age, female sex, obesity, and diabetes mellitus. Little is known about early treatment, inflammation, and PCC. Methods Among 883 individuals with confirmed SARS-CoV-2 infection participating in a randomized trial of CCP vs. control plasma with available biospecimens and symptom data, the association between early COVID treatment, cytokine levels and PCC was evaluated. Cytokine and chemokine levels were assessed at baseline, day 14 and day 90 using a multiplexed sandwich immuosassay (Mesoscale Discovery). Presence of any self-reported PCC symptoms was assessed at day 90. Associations between COVID treatment, cytokine levels and PCC were examined using multivariate logistic regression models. Results One-third of the 882 participants had day 90 PCC symptoms, with fatigue (14.5%) and loss of smell (14.5%) being most common. Cytokine levels decreased from baseline to day 90. In a multivariable analysis including diabetes, body mass index, race, and vaccine status, female sex (adjusted odds ratio[AOR]=2.70[1.93-3.81]), older age (AOR=1.32[1.17-1.50]), and elevated baseline levels of IL-6 (AOR=1.59[1.02-2.47]) were associated with development of PCC.There was a trend for decreased PCC in those with early CCP treatment (≤5 days after symptom onset) compared to late CCP treatment. Conclusion Increased IL-6 levels were associated with the development of PCC and there was a trend for decreased PCC with early CCP treatment in this predominately unvaccinated population. Future treatment studies should evaluate the effect of early treatment and anti-IL-6 therapies on PCC development.
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Affiliation(s)
- Kelly A Gebo
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Sonya L Heath
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL
| | - Yuriko Fukuta
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX
| | - Xianming Zhu
- Department of Pathology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Sheriza Baksh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Alison G Abraham
- Department of Epidemiology, University of Colorado, Anschutz Medical Campus, Aurora CO
| | - Feben Habtehyimer
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - David Shade
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Jessica Ruff
- Department of Pathology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Malathi Ram
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH
| | - Reinaldo E Fernandez
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Eshan U Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Owen R Baker
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Edward R Cachay
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA
| | - Judith S Currier
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA
| | - Jonathan M Gerber
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA
| | | | - Donald N Forthal
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA
| | - Laura L Hammitt
- International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Moises A Huaman
- Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH
| | - Adam Levine
- Department of Emergency Medicine, Rhode Island Hospital Warren Alpert Medical School of Brown University, Providence, RI
| | - Giselle S Mosnaim
- Division of Allergy and Immunology, Department of Medicine, Northshore University Health System, Evanston, IL
| | - Bela Patel
- Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX
| | - James H Paxton
- Department of Emergency Medicine, Wayne State University, Detroit, MI
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, NM
| | - Catherine G Sutcliffe
- International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Shweta Anjan
- Department of Medicine, Department of Medicine, Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL
| | - Thomas Gniadek
- Department of Pathology, Northshore University Health System, Evanston, IL
| | - Seble Kassaye
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Janis E Blair
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ
| | - Karen Lane
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Nichol A McBee
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Amy L Gawad
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Piyali Das
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Sabra L Klein
- Division of Infectious Diseases, Medstar Georgetown University Hospital, Washington, D.C
| | - Andrew Pekosz
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Daniel Hanley
- Department of Neurology, Brain Injury Outcomes Division, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - David J Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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Shoham S, Bloch EM, Casadevall A, Hanley D, Lau B, Gebo K, Cachay E, Kassaye SG, Paxton JH, Gerber J, Levine AC, Naeim A, Currier J, Patel B, Allen ES, Anjan S, Appel L, Baksh S, Blair PW, Bowen A, Broderick P, Caputo CA, Cluzet V, Elena MC, Cruser D, Ehrhardt S, Forthal D, Fukuta Y, Gawad AL, Gniadek T, Hammel J, Huaman MA, Jabs DA, Jedlicka A, Karlen N, Klein S, Laeyendecker O, Karen L, McBee N, Meisenberg B, Merlo C, Mosnaim G, Park HS, Pekosz A, Petrini J, Rausch W, Shade DM, Shapiro JR, Singleton RJ, Sutcliffe C, Thomas DL, Yarava A, Zand M, Zenilman JM, Tobian AA, Sullivan DJ. Transfusing Convalescent Plasma as Post-Exposure Prophylaxis Against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection: A Double-Blinded, Phase 2 Randomized, Controlled Trial. Clin Infect Dis 2023; 76:e477-e486. [PMID: 35579509 PMCID: PMC9129191 DOI: 10.1093/cid/ciac372] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/18/2022] [Accepted: 05/10/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The efficacy of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) convalescent plasma (CCP) for preventing infection in exposed, uninfected individuals is unknown. CCP might prevent infection when administered before symptoms or laboratory evidence of infection. METHODS This double-blinded, phase 2 randomized, controlled trial (RCT) compared the efficacy and safety of prophylactic high titer (≥1:320 by Euroimmun ELISA) CCP with standard plasma. Asymptomatic participants aged ≥18 years with close contact exposure to a person with confirmed coronavirus disease 2019 (COVID-19) in the previous 120 hours and negative SARS-CoV-2 test within 24 hours before transfusion were eligible. The primary outcome was new SARS-CoV-2 infection. RESULTS In total, 180 participants were enrolled; 87 were assigned to CCP and 93 to control plasma, and 170 transfused at 19 sites across the United States from June 2020 to March 2021. Two were excluded for screening SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) positivity. Of the remaining 168 participants, 12/81 (14.8%) CCP and 13/87 (14.9%) control recipients developed SARS-CoV-2 infection; 6 (7.4%) CCP and 7 (8%) control recipients developed COVID-19 (infection with symptoms). There were no COVID-19-related hospitalizations in CCP and 2 in control recipients. Efficacy by restricted mean infection free time (RMIFT) by 28 days for all SARS-CoV-2 infections (25.3 vs 25.2 days; P = .49) and COVID-19 (26.3 vs 25.9 days; P = .35) was similar for both groups. CONCLUSIONS Administration of high-titer CCP as post-exposure prophylaxis, although appearing safe, did not prevent SARS-CoV-2 infection. CLINICAL TRIALS REGISTRATION NCT04323800.
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Affiliation(s)
| | | | | | | | - Bryan Lau
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Mosaic Consulting Ltd., Israel
| | | | - Edward Cachay
- Department of Medicine, Division of Infectious Diseases
| | - Seble G. Kassaye
- Division of Infectious Diseases/Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - James H. Paxton
- Department of Emergency Medicine Wayne State University, Detroit, Michigan, USA
| | - Jonathan Gerber
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worchester, Massachusetts, USA
| | - Adam C Levine
- Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, Rhode Island, USA
| | - Arash Naeim
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, California, USA
| | - Judith Currier
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, California, USA
| | - Bela Patel
- Department of Medicine, Division Critical Care Medicine, University of Texas Health, Houston, Texas, USA
| | - Elizabeth S. Allen
- Department of Pathology, University of California, San Diego, San Diego, California, USA
| | - Shweta Anjan
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Sheriza Baksh
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Mosaic Consulting Ltd., Israel
| | | | | | | | | | - Valerie Cluzet
- Vassar Brothers Medical Center, Nuvance Health, Poughkeepsie, New York, USA
| | | | | | - Stephan Ehrhardt
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Mosaic Consulting Ltd., Israel
| | - Donald Forthal
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, California, USA
| | - Yuriko Fukuta
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | | | - Thomas Gniadek
- Department of Pathology, Northshore University Health System, Evanston, Illinois, USA
| | | | - Moises A. Huaman
- Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati, Ohio, USA
| | - Douglas A. Jabs
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | - Sabra Klein
- Department of Molecular Microbiology and Immunology
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, USA
| | | | | | | | | | | | - Han-Sol Park
- Department of Molecular Microbiology and Immunology
| | | | - Joann Petrini
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, USA
| | - William Rausch
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, USA
| | - David M. Shade
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Mosaic Consulting Ltd., Israel
| | | | | | - Catherine Sutcliffe
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Mosaic Consulting Ltd., Israel
| | | | | | - Martin Zand
- Department of Medicine, University of Rochester, Rochester, New York, USA
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Sparks R, Lau WW, Liu C, Han KL, Vrindten KL, Sun G, Cox M, Andrews SF, Bansal N, Failla LE, Manischewitz J, Grubbs G, King LR, Koroleva G, Leimenstoll S, Snow L, Chen J, Tang J, Mukherjee A, Sellers BA, Apps R, McDermott AB, Martins AJ, Bloch EM, Golding H, Khurana S, Tsang JS. Influenza vaccination reveals sex dimorphic imprints of prior mild COVID-19. Nature 2023; 614:752-761. [PMID: 36599369 PMCID: PMC10481789 DOI: 10.1038/s41586-022-05670-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 12/19/2022] [Indexed: 01/05/2023]
Abstract
Acute viral infections can have durable functional impacts on the immune system long after recovery, but how they affect homeostatic immune states and responses to future perturbations remain poorly understood1-4. Here we use systems immunology approaches, including longitudinal multimodal single-cell analysis (surface proteins, transcriptome and V(D)J sequences) to comparatively assess baseline immune statuses and responses to influenza vaccination in 33 healthy individuals after recovery from mild, non-hospitalized COVID-19 (mean, 151 days after diagnosis) and 40 age- and sex-matched control individuals who had never had COVID-19. At the baseline and independent of time after COVID-19, recoverees had elevated T cell activation signatures and lower expression of innate immune genes including Toll-like receptors in monocytes. Male individuals who had recovered from COVID-19 had coordinately higher innate, influenza-specific plasmablast, and antibody responses after vaccination compared with healthy male individuals and female individuals who had recovered from COVID-19, in part because male recoverees had monocytes with higher IL-15 responses early after vaccination coupled with elevated prevaccination frequencies of 'virtual memory'-like CD8+ T cells poised to produce more IFNγ after IL-15 stimulation. Moreover, the expression of the repressed innate immune genes in monocytes increased by day 1 to day 28 after vaccination in recoverees, therefore moving towards the prevaccination baseline of the healthy control individuals. By contrast, these genes decreased on day 1 and returned to the baseline by day 28 in the control individuals. Our study reveals sex-dimorphic effects of previous mild COVID-19 and suggests that viral infections in humans can establish new immunological set-points that affect future immune responses in an antigen-agnostic manner.
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Affiliation(s)
- Rachel Sparks
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA
| | - William W Lau
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA
| | - Can Liu
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA
- Graduate Program in Biological Sciences, University of Maryland, College Park, MD, USA
| | - Kyu Lee Han
- NIH Center for Human Immunology, NIAID, NIH, Bethesda, MD, USA
| | - Kiera L Vrindten
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA
| | - Guangping Sun
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA
- Division of Intramural Research, NIAID, NIH, Bethesda, MD, USA
| | - Milann Cox
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA
| | | | - Neha Bansal
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA
| | - Laura E Failla
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA
| | - Jody Manischewitz
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, USA
| | - Gabrielle Grubbs
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, USA
| | - Lisa R King
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, USA
| | - Galina Koroleva
- NIH Center for Human Immunology, NIAID, NIH, Bethesda, MD, USA
| | | | - LaQuita Snow
- Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD, USA
- Johns Hopkins University, Baltimore, MD, USA
| | - Jinguo Chen
- NIH Center for Human Immunology, NIAID, NIH, Bethesda, MD, USA
| | - Juanjie Tang
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, USA
| | | | - Brian A Sellers
- NIH Center for Human Immunology, NIAID, NIH, Bethesda, MD, USA
| | - Richard Apps
- NIH Center for Human Immunology, NIAID, NIH, Bethesda, MD, USA
| | | | - Andrew J Martins
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hana Golding
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, USA
| | - Surender Khurana
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, USA
| | - John S Tsang
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA.
- NIH Center for Human Immunology, NIAID, NIH, Bethesda, MD, USA.
- Yale Center for Systems and Engineering Immunology and Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA.
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA.
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40
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Focosi D, Senefeld JW, Joyner MJ, Sullivan D, Casadevall A, Bloch EM, Franchini M. Lower anti-spike levels in B-cell-depleted patients after convalescent plasma transfusion suggest the need for repeated doses. Br J Haematol 2023; 200:e22-e24. [PMID: 36342497 DOI: 10.1111/bjh.18544] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, Pisa, Italy
| | - Jonathon W Senefeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - David Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of medicine, Baltimore, Maryland, USA
| | - Massimo Franchini
- Division of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantua, Italy
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41
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Spencer BR, White JL, Patel EU, Goel R, Bloch EM, Tobian AA. Eligibility Considerations for Female Whole Blood Donors: Hemoglobin Levels and Iron Status in a Nationally Representative Population. Transfus Med Rev 2023; 37:27-35. [PMID: 36528466 PMCID: PMC10787604 DOI: 10.1016/j.tmrv.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/15/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022]
Abstract
Blood collection from minority populations improves the transfusion support of patients with sickle cell disease and thalassemia, but efforts are challenged by high deferral rates for hemoglobin (Hb) eligibility thresholds. This study sought to evaluate hemoglobin and iron status of a representative US female population to assess the suitability of 12.0 g/dL as minimum hemoglobin. Data were extracted from the National Health and Nutrition Examination Surveys (NHANES), 1999-2010. A national sample designed to reflect potential female blood donors (weight ≥110 lbs, not pregnant, no infectious marker reactivity, and no blood donation in past year) aged 16 to 49 years was analyzed for Hb and serum ferritin (SF) measures by race/ethnicity (N = 6937). Mean Hb and SF and the prevalence of iron deficiency ([ID] SF<12 ng/mL and SF<26 ng/mL) and low Hb (<12.5 g/dL and <12.0 g/dL) were estimated. Multivariable modified Poisson regression compared the prevalence for ID or low Hb at each cutoff by race/ethnicity. Mean SF values were higher and ID prevalence was lower in Non-Hispanic (NH) White (SF = 45.3 ng/mL, SF<12 ng/mL = 8.2%) than NH Black (SF = 39.6 ng/mL, SF<12 ng/mL = 14.2%) and Hispanic (SF = 36.5 ng/mL, SF<12 ng/mL = 12.7%) females. Compared to NH White females (13.7 g/dL), mean Hb was lower in NH Black (12.6 g/dL) and Hispanic females (13.4 g/dL). The percentage with Hb<12.5 g/dL was >4 times greater in NH Black (39.1%) and >2 times greater in Hispanic females (16.5%) compared to NH White (8.6%). Within 0.5 g/dL incremental categories of Hb, NH Black had higher mean SF levels and lower prevalence of SF<12 ng/mL or <26 ng/mL compared to NH White and Hispanic females. At Hb of 12.0 to 12.4g/dL, NH Black females had better measures of iron status (SF = 39.1 ng/mL, %SF<12 ng/mL = 12.0%) than NH White (SF = 33.6 ng/mL, %SF<12 ng/mL=15.8%) and Hispanic (SF = 30.4 ng/mL, %SF<12 ng/mL=15.5%) females whose Hb was 12.5 to 12.9 g/dL. Adjusting for age and Hb, the prevalence ratio for low SF was significantly lower in NH Black compared to NH White females at both SF<26 ng/mL (adjusted prevalence ratio [aPR] = 0.83, 95%CI = 0.76-0.92) and SF<12 ng/mL (aPR = 0.66, 95%CI = 0.52-0.83). NH Black females with Hb 12.0 to 12.4g/dL have better iron stores than NH White and Hispanic females whose Hb is 12.5 to 12.9 g/dL. The distribution of Hb and iron may support the safe collection of blood for female donors below the current Hb eligibility requirement of 12.5 g/dL.
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Affiliation(s)
| | - Jodie L White
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Eshan U Patel
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ruchika Goel
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Aaron Ar Tobian
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
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42
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Kandathil AJ, Benner SE, Bloch EM, Shrestha R, Ajayi O, Zhu X, Caturegli PP, Shoham S, Sullivan D, Gebo K, Quinn TC, Casadevall A, Hanley D, Pekosz A, Redd AD, Balagopal A, Tobian AAR. Absence of pathogenic viruses in COVID-19 convalescent plasma. Transfusion 2023; 63:23-29. [PMID: 36268708 PMCID: PMC9840666 DOI: 10.1111/trf.17168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND It is important to maintain the safety of blood products by avoiding the transfusion of units with known and novel viral pathogens. It is unknown whether COVID-19 convalescent plasma (CCP) may contain pathogenic viruses (either newly acquired or reactivated) that are not routinely screened for by blood centers. METHODS The DNA virome was characterized in potential CCP donors (n = 30) using viral genome specific PCR primers to identify DNA plasma virome members of the Herpesviridae [Epstein Barr Virus (EBV), cytomegalovirus (CMV), human herpesvirus 6A/B, human herpesvirus 7] and Anelloviridae [Torque teno viruses (TTV), Torque teno mini viruses (TTMV), and Torque teno midi viruses (TTMDV)] families. In addition, the RNA plasma virome was characterized using unbiased metagenomic sequencing. Sequencing was done on a HiSeq2500 using high output mode with a read length of 2X100 bp. The sequencing reads were taxonomically classified using Kraken2. CMV and EBV seroprevalence were evaluated using a chemiluminescent immunoassay. RESULTS TTV and TTMDV were detected in 12 (40%) and 4 (13%) of the 30 study participants, respectively; TTMDV was always associated with infection with TTV. We did not observe TTMV DNAemia. Despite CMV and EBV seroprevalences of 33.3% and 93.3%, respectively, we did not detect Herpesviridae DNA among the study participants. Metagenomic sequencing did not reveal any human RNA viruses in CCP, including no evidence of circulating SARS-CoV-2. DISCUSSION There was no evidence of pathogenic viruses, whether newly acquired or reactivated, in CCP despite the presence of non-pathogenic Anelloviridae. These results confirm the growing safety data supporting CCP.
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Affiliation(s)
- Abraham J Kandathil
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sarah E Benner
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ruchee Shrestha
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Olivia Ajayi
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Xianming Zhu
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Patrizio P Caturegli
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shmuel Shoham
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - David Sullivan
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kelly Gebo
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Thomas C Quinn
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Daniel Hanley
- Department of Neurology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andrew Pekosz
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andrew D Redd
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Ashwin Balagopal
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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43
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Kostandova N, Drabo EF, Yenokyan K, Wesolowski A, Truelove S, Bloch EM, Tobian AAR, Vassallo RR, Bravo MD, Casadevall A, Lessler J, Lau B. Comparison of allocation strategies of convalescent plasma to reduce excess infections and mortality from SARS-CoV-2 in a US-like population. Transfusion 2023; 63:92-103. [PMID: 36345608 PMCID: PMC9878275 DOI: 10.1111/trf.17174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/02/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND While the use of convalescent plasma (CP) in the ongoing COVID-19 pandemic has been inconsistent, CP has the potential to reduce excess morbidity and mortality in future pandemics. Given constraints on CP supply, decisions surrounding the allocation of CP must be made. STUDY DESIGN AND METHODS Using a discrete-time stochastic compartmental model, we simulated implementation of four potential allocation strategies: administering CP to individuals in early hospitalization with COVID-19; administering CP to individuals in outpatient settings; administering CP to hospitalized individuals and administering any remaining CP to outpatient individuals and administering CP in both settings while prioritizing outpatient individuals. We examined the final size of SARS-CoV-2 infections, peak and cumulative hospitalizations, and cumulative deaths under each of the allocation scenarios over a 180-day period. We compared the cost per weighted health benefit under each strategy. RESULTS Prioritizing administration to patients in early hospitalization, with remaining plasma administered in outpatient settings, resulted in the highest reduction in mortality, averting on average 15% more COVID-19 deaths than administering to hospitalized individuals alone (95% CI [11%-18%]). Prioritizing administration to outpatients, with remaining plasma administered to hospitalized individuals, had the highest percentage of hospitalizations averted (22% [21%-23%] higher than administering to hospitalized individuals alone). DISCUSSION Convalescent plasma allocation strategy should be determined by the relative priority of averting deaths, infections, or hospitalizations. Under conditions considered, mixed allocation strategies (allocating CP to both outpatient and hospitalized individuals) resulted in a larger percentage of infections and deaths averted than administering CP in a single setting.
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Affiliation(s)
- Natalya Kostandova
- Department of Epidemiology, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Emmanuel Fulgence Drabo
- Department of Health Policy and Management, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Karine Yenokyan
- Department of Epidemiology, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Amy Wesolowski
- Department of Epidemiology, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Shaun Truelove
- Department of Epidemiology, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of International Health, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Evan M. Bloch
- Division of Transfusion Medicine, Department of Pathology, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Aaron A. R. Tobian
- Division of Transfusion Medicine, Department of Pathology, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | | | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Justin Lessler
- Department of Epidemiology, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of Epidemiology, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
- Carolina Population CenterUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Bryan Lau
- Department of Epidemiology, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
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44
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Mercure-Corriveau N, O'Brien C, Garg A, Crowe EP, Bloch EM, Tobian AAR. Therapeutic plasma exchange for the treatment of extracorporeal membrane oxygenation dysfunction caused by hypertriglyceridemia. Transfusion 2022; 62:2427-2428. [PMID: 35975478 DOI: 10.1111/trf.17070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Nicolas Mercure-Corriveau
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Caitlin O'Brien
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anjali Garg
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth P Crowe
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Evan M Bloch
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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45
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Bloch EM, Zhu X, Krause PJ, Patel EU, Grabowski MK, Goel R, Auwaerter PG, Tobian AAR. Comparing the Epidemiology and Health Burden of Lyme Disease and Babesiosis Hospitalizations in the United States. Open Forum Infect Dis 2022; 9:ofac597. [PMID: 36467296 PMCID: PMC9709699 DOI: 10.1093/ofid/ofac597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
Background Lyme disease (LD) and babesiosis are increasing in the United States. We sought to characterize and compare their epidemiology and health burden using a nationally representative sample of hospitalizations. Methods Data were extracted from the National Inpatient Sample (NIS) pertaining to LD and babesiosis for 2018 and 2019. The NIS is a comprehensive database of all-payer inpatient hospitalizations, representing a stratified systematic random sample of discharges from US hospitals. Patient demographics, clinical outcomes, and admission costs were evaluated, in addition to hospital-level variables (eg, location/teaching status and census division). Annual incidence of hospitalizations was calculated using US Census Bureau data. Results The annual incidence of hospitalizations of LD-related and babesiosis-related hospitalizations were 6.98 and 2.03 per 1 000 000 persons/year. Of the 4585 LD hospitalizations in 2018-2019, 60.9% were among male patients, 85.3% were White, and 39.0% were ≥60 years. Of the 1330 babesiosis hospitalizations in 2018-2019, 72.2% were among male patients, 78.9% were White, and 74.1% were ≥60 years; 70.0% of LD and 91.7% of babesiosis hospitalizations occurred in Middle Atlantic or New England. Lower disease severity was noted in 81.8% of LD hospitalizations compared with 49.3% of babesiosis hospitalizations, whereas those suffering from high severity were 2.3% and 6.0%, respectively. The mean hospital charges for LD and babesiosis hospitalizations were $33 440.8 and $40 689.8, respectively. Conclusions Despite overlap between the 2 diseases, LD has a broader geographic range and a greater number of hospital admissions, whereas babesiosis is more severe, incurring longer hospital stays, higher inpatient costs, and deaths.
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Affiliation(s)
- Evan M Bloch
- Correspondence: Evan M. Bloch, MBChB, MS, Associate Professor of Pathology, Associate Director, Transfusion Medicine, Department of Pathology, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street, Carnegie 446 D1, Baltimore, MD 21287 ()
| | - Xianming Zhu
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Peter J Krause
- Department of Epidemiology and Public Health, Yale School of Public Health and Yale School of Medicine, New Haven, Connecticut, USA
| | - Eshan U Patel
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - M Kate Grabowski
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ruchika Goel
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Internal Medicine, Simmons Cancer Institute at Southern Illinois University, Springfield, Illinois, USA
| | - Paul G Auwaerter
- Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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46
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Hederman AP, Natarajan H, Wiener JA, Wright PF, Bloch EM, Tobian AA, Redd AD, Blankson JN, Rottenstreich A, Zarbiv G, Wolf D, Goetghebuer T, Marchant A, Ackerman ME. SARS-CoV-2 mRNA vaccination elicits broad and potent Fc effector functions to VOCs in vulnerable populations. medRxiv 2022:2022.09.15.22280000. [PMID: 36172122 PMCID: PMC9516864 DOI: 10.1101/2022.09.15.22280000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
SARS-CoV-2 variants have continuously emerged even as highly effective vaccines have been widely deployed. Reduced neutralization observed against variants of concern (VOC) raises the question as to whether other antiviral antibody activities are similarly compromised, or if they might compensate for lost neutralization activity. In this study, the breadth and potency of antibody recognition and effector function was surveyed in both healthy individuals as well as immunologically vulnerable subjects following either natural infection or receipt of an mRNA vaccine. Considering pregnant women as a model cohort with higher risk of severe illness and death, we observed similar binding and functional breadth for healthy and immunologically vulnerable populations. In contrast, considerably greater functional antibody breadth and potency across VOC was associated with vaccination than prior infection. However, greater antibody functional activity targeting the endemic coronavirus OC43 was noted among convalescent individuals, illustrating a dichotomy in recognition between close and distant human coronavirus strains that was associated with exposure history. Probing the full-length spike and receptor binding domain (RBD) revealed that antibody-mediated Fc effector functions were better maintained against full-length spike as compared to RBD. This analysis of antibody functions in healthy and vulnerable populations across a panel of SARS-CoV-2 VOC and extending through endemic alphacoronavirus strains suggests the differential potential for antibody effector functions to contribute to protecting vaccinated and convalescent subjects as the pandemic progresses and novel variants continue to evolve. One Sentence Summary As compared to natural infection with SARS-CoV-2, vaccination drives superior functional antibody breadth raising hopes for candidate universal CoV vaccines.
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Affiliation(s)
| | - Harini Natarajan
- Department of Immunology and Microbiology, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA
| | - Joshua A. Wiener
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Peter F. Wright
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Evan M. Bloch
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Aaron A.R. Tobian
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Andrew D. Redd
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Joel N. Blankson
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center
| | - Gila Zarbiv
- Clinical Virology Unit, Hadassah University Medical Center, Jerusalem, Israel
| | - Dana Wolf
- Clinical Virology Unit, Hadassah University Medical Center, Jerusalem, Israel
| | - Tessa Goetghebuer
- Institute for Medical Immunology, Université libre de Bruxelles, Charleroi, Belgium
- Pediatric Department, CHU St Pierre, Brussels, Belgium
| | - Arnaud Marchant
- Institute for Medical Immunology, Université libre de Bruxelles, Charleroi, Belgium
| | - Margaret E. Ackerman
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
- Department of Immunology and Microbiology, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA
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47
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Al-Riyami AZ, Estcourt L, Rahimi-Levene N, Bloch EM, Goel R, Tiberghien P, Thibert JB, Bruun MT, Devine DV, Gammon RR, Wendel S, Toungouz Nevessignsky M, Grubovic Rastvorceva RM, Oreh A, Romon I, van den Berg K, Kitazawa J, Patidar G, So-Osman C, Wood EM. Early and out-of-hospital use of COVID-19 convalescent plasma: An international assessment of utilization and feasibility. Vox Sang 2022; 117:1202-1210. [PMID: 36102139 PMCID: PMC9538090 DOI: 10.1111/vox.13347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives The use of coronavirus disease 2019 (COVID‐19) convalescent plasma (CCP) in the treatment of patients with severe acute respiratory syndrome‐2 infection has been controversial. Early administration of CCP before hospital admission offers a potential advantage. This manuscript summarizes current trials of early use of CCP and explores the feasibility of this approach in different countries. Materials and Methods A questionnaire was distributed to the International Society of Blood Transfusion (ISBT) CCP working group. We recorded respondents' input on existing trials on early/outpatient CCP and out‐of‐hospital (OOH)/home transfusion (HT) practices in their countries and feedback on challenges in initiating home CCP infusion programmes. In addition, details of existing trials registered on clinicaltrials.gov were summarized. Results A total of 31 country representatives participated. Early/OOH CCP transfusion studies were reported in the United States, the Netherlands, Spain and Brazil. There were a total of six published and five ongoing trials on the prophylactic and therapeutic early use of CCP. HT was practised in Australia, the UK, Belgium, France, Japan, Nigeria, the Netherlands, Spain, Italy, Norway, the United States and some provinces in Canada. Thirty‐four representatives indicated a lack of OOH CCP or HT in their institutions and countries. Barriers to implementation of OOH/HT included existing legislation, lack of policies pertaining to outpatient transfusion, and associated logistical challenges, including lack of staffing and resources. Conclusion Early administration of CCP remains a potential option in COVID‐19 management in countries with existing OOH/HT programmes. Legislation and regulatory bodies should consider OOH/HT practice for transfusion in future pandemics.
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Affiliation(s)
- Arwa Z Al-Riyami
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Lise Estcourt
- NHS Blood and Transplant & Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ruchika Goel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,ImpactLife Blood Centre and Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | | | | | - Mie Topholm Bruun
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Dana V Devine
- Centre for Innovation, Canadian Blood Services, Vancouver, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, Canada
| | - Richard R Gammon
- Scientific Medical and Technical Direction, OneBlood, Orlando, Florida, USA
| | - Silvano Wendel
- Blood Bank, Hospital Sírio-Libanês Blood Bank, São Paulo, Brazil
| | | | - Rada M Grubovic Rastvorceva
- Institute for Transfusion Medicine of RNM, Skopje, North Macedonia.,Faculty of Medical Sciences, University Goce Delcev, Štip, North Macedonia
| | - Adaeze Oreh
- National Blood Service Commission, Federal Ministry of Health, Abuja, Nigeria
| | - Iñigo Romon
- Hematology Department, University Hospital Marques de Valdecilla, Santander, Spain
| | - Karin van den Berg
- Transfusion Medicine and Technical Services Division, South African National Blood Service, Johannesburg, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa.,Division of Clinical Haematology, University of the Free State, Bloemfontein, South Africa
| | - Junichi Kitazawa
- Department of Genomic Medicine, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Gopal Patidar
- Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Cynthia So-Osman
- Unit Transfusion Medicine, Sanquin Blood Bank, Amsterdam, the Netherlands.,Department of Haematology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Erica M Wood
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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48
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Sparks R, Lau WW, Liu C, Han KL, Vrindten KL, Sun G, Cox M, Andrews SF, Bansal N, Failla LE, Manischewitz J, Grubbs G, King LR, Koroleva G, Leimenstoll S, Snow L, Chen J, Tang J, Mukherjee A, Sellers BA, Apps R, McDermott AB, Martins AJ, Bloch EM, Golding H, Khurana S, Tsang JS. Influenza vaccination and single cell multiomics reveal sex dimorphic immune imprints of prior mild COVID-19. medRxiv 2022:2022.02.17.22271138. [PMID: 35233581 PMCID: PMC8887138 DOI: 10.1101/2022.02.17.22271138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Viral infections can have profound and durable functional impacts on the immune system. There is an urgent need to characterize the long-term immune effects of SARS-CoV-2 infection given the persistence of symptoms in some individuals and the continued threat of novel variants. Here we use systems immunology, including longitudinal multimodal single cell analysis (surface proteins, transcriptome, and V(D)J sequences) from 33 previously healthy individuals after recovery from mild, non-hospitalized COVID-19 and 40 age- and sex-matched healthy controls with no history of COVID-19 to comparatively assess the post-infection immune status (mean: 151 days after diagnosis) and subsequent innate and adaptive responses to seasonal influenza vaccination. Identification of both sex-specific and -independent temporally stable changes, including signatures of T-cell activation and repression of innate defense/immune receptor genes (e.g., Toll-like receptors) in monocytes, suggest that mild COVID-19 can establish new post-recovery immunological set-points. COVID-19-recovered males had higher innate, influenza-specific plasmablast, and antibody responses after vaccination compared to healthy males and COVID-19-recovered females, partly attributable to elevated pre-vaccination frequencies of a GPR56 expressing CD8+ T-cell subset in male recoverees that are "poised" to produce higher levels of IFNγ upon inflammatory stimulation. Intriguingly, by day 1 post-vaccination in COVID-19-recovered subjects, the expression of the repressed genes in monocytes increased and moved towards the pre-vaccination baseline of healthy controls, suggesting that the acute inflammation induced by vaccination could partly reset the immune states established by mild COVID-19. Our study reveals sex-dimorphic immune imprints and in vivo functional impacts of mild COVID-19 in humans, suggesting that prior COVID-19, and possibly respiratory viral infections in general, could change future responses to vaccination and in turn, vaccines could help reset the immune system after COVID-19, both in an antigen-agnostic manner.
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Affiliation(s)
- Rachel Sparks
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA,These authors contributed equally
| | - William W. Lau
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA,These authors contributed equally
| | - Can Liu
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA,Graduate Program in Biological Sciences, University of Maryland, College Park, MD, USA,These authors contributed equally
| | - Kyu Lee Han
- NIH Center for Human Immunology, NIAID, NIH, Bethesda, MD, USA
| | - Kiera L. Vrindten
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA
| | - Guangping Sun
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA,Division of Intramural Research, NIAID, NIH, Bethesda, MD, USA
| | - Milann Cox
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA
| | | | - Neha Bansal
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA
| | - Laura E. Failla
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA
| | - Jody Manischewitz
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, USA
| | - Gabrielle Grubbs
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, USA
| | - Lisa R. King
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, USA
| | - Galina Koroleva
- NIH Center for Human Immunology, NIAID, NIH, Bethesda, MD, USA
| | | | - LaQuita Snow
- Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD, USA
| | | | - Jinguo Chen
- NIH Center for Human Immunology, NIAID, NIH, Bethesda, MD, USA
| | - Juanjie Tang
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, USA
| | | | | | - Richard Apps
- NIH Center for Human Immunology, NIAID, NIH, Bethesda, MD, USA
| | | | - Andrew J. Martins
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA
| | - Evan M. Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hana Golding
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, USA
| | - Surender Khurana
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, USA
| | - John S. Tsang
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA,NIH Center for Human Immunology, NIAID, NIH, Bethesda, MD, USA,Correspondence:
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49
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Estcourt LJ, Cohn CS, Pagano MB, Iannizzi C, Kreuzberger N, Skoetz N, Allen ES, Bloch EM, Beaudoin G, Casadevall A, Devine DV, Foroutan F, Gniadek TJ, Goel R, Gorlin J, Grossman BJ, Joyner MJ, Metcalf RA, Raval JS, Rice TW, Shaz BH, Vassallo RR, Winters JL, Tobian AAR. Clinical Practice Guidelines From the Association for the Advancement of Blood and Biotherapies (AABB): COVID-19 Convalescent Plasma. Ann Intern Med 2022; 175:1310-1321. [PMID: 35969859 PMCID: PMC9450870 DOI: 10.7326/m22-1079] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
DESCRIPTION Coronavirus disease 2019 convalescent plasma (CCP) has emerged as a potential treatment of COVID-19. However, meta-analysis data and recommendations are limited. The Association for the Advancement of Blood and Biotherapies (AABB) developed clinical practice guidelines for the appropriate use of CCP. METHODS These guidelines are based on 2 living systematic reviews of randomized controlled trials (RCTs) evaluating CCP from 1 January 2019 to 26 January 2022. There were 33 RCTs assessing 21 916 participants. The results were summarized using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method. An expert panel reviewed the data using the GRADE framework to formulate recommendations. RECOMMENDATION 1 (OUTPATIENT) The AABB suggests CCP transfusion in addition to the usual standard of care for outpatients with COVID-19 who are at high risk for disease progression (weak recommendation, moderate-certainty evidence). RECOMMENDATION 2 (INPATIENT) The AABB recommends against CCP transfusion for unselected hospitalized persons with moderate or severe disease (strong recommendation, high-certainty evidence). This recommendation does not apply to immunosuppressed patients or those who lack antibodies against SARS-CoV-2. RECOMMENDATION 3 (INPATIENT) The AABB suggests CCP transfusion in addition to the usual standard of care for hospitalized patients with COVID-19 who do not have SARS-CoV-2 antibodies detected at admission (weak recommendation, low-certainty evidence). RECOMMENDATION 4 (INPATIENT) The AABB suggests CCP transfusion in addition to the usual standard of care for hospitalized patients with COVID-19 and preexisting immunosuppression (weak recommendation, low-certainty evidence). RECOMMENDATION 5 (PROPHYLAXIS) The AABB suggests against prophylactic CCP transfusion for uninfected persons with close contact exposure to a person with COVID-19 (weak recommendation, low-certainty evidence). GOOD CLINICAL PRACTICE STATEMENT CCP is most effective when transfused with high neutralizing titers to infected patients early after symptom onset.
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Affiliation(s)
- Lise J Estcourt
- NHS Blood and Transplant and Radcliffe Department of Medicine, University of Oxford, United Kingdom (L.J.E.)
| | - Claudia S Cohn
- University of Minnesota, Department of Laboratory Medicine and Pathology, Minneapolis, Minnesota (C.S.C.)
| | - Monica B Pagano
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, Washington (M.B.P.)
| | - Claire Iannizzi
- Evidence-based Oncology, Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (C.I., N.K., N.S.)
| | - Nina Kreuzberger
- Evidence-based Oncology, Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (C.I., N.K., N.S.)
| | - Nicole Skoetz
- Evidence-based Oncology, Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (C.I., N.K., N.S.)
| | - Elizabeth S Allen
- University of California San Diego, Department of Pathology, La Jolla, California (E.S.A.)
| | - Evan M Bloch
- The Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, Maryland (E.M.B., R.G., A.A.R.T.)
| | | | - Arturo Casadevall
- The Johns Hopkins University School of Public Health, Department of Molecular Microbiology and Immunology, Baltimore, Maryland (A.C.)
| | - Dana V Devine
- Canadian Blood Services, Vancouver, British Columbia, Canada (D.V.D.)
| | - Farid Foroutan
- University Health Network, Ted Rogers Centre for Heart Research, Toronto, and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (F.F.)
| | - Thomas J Gniadek
- NorthShore University Health System, Department of Pathology and Laboratory Medicine, Evanston, Illinois (T.J.G.)
| | - Ruchika Goel
- The Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, Maryland (E.M.B., R.G., A.A.R.T.)
| | - Jed Gorlin
- Innovative Blood Resources, Division of New York Blood Center Enterprises, St. Paul, Minnesota (J.G.)
| | - Brenda J Grossman
- Washington University in St. Louis School of Medicine, Department of Pathology and Immunology, St. Louis, Missouri (B.J.G.)
| | - Michael J Joyner
- Mayo Clinic, Department of Anesthesiology and Perioperative Medicine, Rochester, Minnesota (M.J.J.)
| | - Ryan A Metcalf
- University of Utah, Department of Pathology, Salt Lake City, Utah (R.A.M.)
| | - Jay S Raval
- University of New Mexico, Department of Pathology, Albuquerque, New Mexico (J.S.R.)
| | - Todd W Rice
- Vanderbilt University Medical Center, Division of Allergy, Pulmonary, and Critical Care Medicine, Nashville, Tennessee (T.W.R.)
| | - Beth H Shaz
- Duke University, Department of Pathology, Durham, North Carolina (B.H.S.)
| | | | - Jeffrey L Winters
- Mayo Clinic, Department of Laboratory Medicine and Pathology, Rochester, Minnesota (J.L.W.)
| | - Aaron A R Tobian
- The Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, Maryland (E.M.B., R.G., A.A.R.T.)
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50
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Buban KR, Lawrence CE, Zhu XJ, Tobian AAR, Gehrie EA, Vozniak S, Shrestha R, Lokhandwala PM, Bloch EM. Algorithm‐based selection of automated red blood cell exchange procedure goals reduces blood utilization in chronically transfused adults with sickle cell disease. J Clin Apher 2022; 37:468-475. [DOI: 10.1002/jca.22004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 05/11/2022] [Accepted: 06/22/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Kristen R. Buban
- Division of Transfusion Medicine, Department of Pathology Johns Hopkins University Baltimore Maryland USA
| | - Courtney E. Lawrence
- Division of Transfusion Medicine, Department of Pathology Johns Hopkins University Baltimore Maryland USA
| | - Xianming Joshua Zhu
- Division of Transfusion Medicine, Department of Pathology Johns Hopkins University Baltimore Maryland USA
| | - Aaron A. R. Tobian
- Division of Transfusion Medicine, Department of Pathology Johns Hopkins University Baltimore Maryland USA
| | | | - Sonja Vozniak
- Division of Transfusion Medicine, Department of Pathology Johns Hopkins University Baltimore Maryland USA
| | - Ruchee Shrestha
- Division of Transfusion Medicine, Department of Pathology Johns Hopkins University Baltimore Maryland USA
| | | | - Evan M. Bloch
- Division of Transfusion Medicine, Department of Pathology Johns Hopkins University Baltimore Maryland USA
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